MR. BRENT CHARLES RUSSELL (NPI# 1255412318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255412318 |
| Entity Type | Individual |
| Full Name | MR. BRENT CHARLES RUSSELL |
| Credential | P.A.-C. |
| Practice Address |
43145 Schoenherr Rd Sterling Heights MI 48313-1955 |
| Mailing Address |
12685 Highland Rd Hartland MI 48353-2933 |
| Practice Telephone | 5899975048 |
| Practice Fax Number | 5899975049 |
| Mailing Telephone | 4198654448 |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-03-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
5601002647 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
50-00-0863 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MR1896882 | 01 | |
| MI | PAIN MANAGEMENT | 5601002647 | 01 |
| OH | CERTIFICATE TO PRESCRIBE | 55.000448 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801206172 | Brent Da Silva Russell | Chiropractor | 4082 Nancy Creek Way Ne, Atlanta, GA 30319-1738 | 2014-05-07 |
| 1316456056 | Brent Russell | Social Worker | 4271 Hempstead Tpke, Bethpage, NY 11714-5708 | 2017-09-26 |
| 1851461842 | Brent Austin Russell | Emergency Medicine | 9205 Sw Barnes Rd, Portland, OR 97225-6603 | 2006-11-08 |
| Street Address |
43145 SCHOENHERR RD |
| City | STERLING HEIGHTS |
| State | MI |
| Zip Code | 48313-1955 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548207467 | Kuldip S. Deogun, Md, PC | Nurse Practitioner | 43145 Schoenherr Rd, Unit #13, Sterling Heights, MI 48313-1955 | 2006-05-31 |
| 1902389372 | Jessica Cooper | Registered Nurse | 43145 Schoenherr Rd, Sterling Heights, MI 48313-1955 | 2018-09-12 |
| 1134424021 | Farah S Alrais | Physician Assistant | 43145 Schoenherr Rd, Suite 200, Sterling Heights, MI 48313-1955 | 2011-01-24 |
| 1053352120 | Michelle L Simpson | Specialist | 43145 Schoenherr Rd, Sterling Heights, MI 48313-1955 | 2006-06-09 |
| 1346288750 | Kuldip S Deogun | Anesthesiology | 43145 Schoenherr Rd, Unit #13, Sterling Heights, MI 48313-1955 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417435397 | Britany Lee Colonna | Technician/Technologist | 39100 Augusta Ave, Sterling Heights, MI 48313 | 2018-08-01 |
| 1871012245 | Amy Lechtenberg | Midwife | 42248 Montroy Dr, Sterling Heights, MI 48313 | 2017-09-16 |
| 1770012064 | Emily Bedy | Specialist/Technologist | 15004 Bridgeview Dr, Sterling Heights, MI 48313 | 2017-06-08 |
| 1801347174 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 14200 Lakeside Cir, Sterling Heights, MI 48313 | 2016-10-20 |
| 1225407653 | Diana Hill | Registered Nurse | 433361 Cape Dr, Sterling Heights, MI 48313 | 2015-09-16 |
| 1104202845 | Xhesika Tasi | Licensed Practical Nurse | 44208 Orchard Ln, Sterling Heights, MI 48313 | 2015-08-05 |
| 1740698604 | Star Behavior Consultants, LLC | Community/Behavioral Health | 12231 N York Dr, Sterling Heights, MI 48313 | 2014-07-23 |
| 1215348529 | Care Counseling Solutions LLC | Social Worker | 11945 19 Mile Rd, Sterling Heights, MI 48313 | 2014-05-09 |
| 1326462870 | Lauren Rae Gomes | Chiropractor | 13919 19 Mile Rd, Sterling Heights, MI 48313 | 2014-02-04 |
| 1760625776 | Deborah Ann Langlois | Pharmacist | 13500 19 Mile Road, Sterling Heights, MI 48313 | 2009-04-07 |
| Find all providers in zip 48313 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639777287 | Piotr Z Purzycki | Physician Assistant | 41400 Dequindre Rd Ste 101, Sterling Heights, MI 48314-3751 | 2020-10-15 |
| 1871090308 | Geri Lynn Garlo | Physician Assistant | 35200 Dequindre Rd Ste 600, Sterling Heights, MI 48310-4841 | 2018-04-11 |
| 1508236704 | Michelle Karwowski | Physician Assistant | 33464 Schoenherr Rd Ste 160, Sterling Heights, MI 48312-6392 | 2015-09-30 |
| 1023327483 | Robbie William Roesch | Physician Assistant | 2405 E. Fourteen Mile Rd., Sterling Heights, MI 48310 | 2010-10-04 |
| 1942295837 | Nellynn L. Hatch | Physician Assistant | 44344 Dequindre Rd Ste 260, Sterling Heights, MI 48314-1040 | 2005-09-16 |
| 1871067272 | Alexandrea Raad | Physician Assistant | 43455 Schoenherr Rd Ste 2, Sterling Heights, MI 48313-1972 | 2019-01-18 |
| 1568740918 | Brooke L. Tobia | Physician Assistant | 2405 E 14 Mile Rd, Sterling Heights, MI 48310-5961 | 2011-08-02 |
| 1033444369 | Danielle E Braniecki | Physician Assistant | 33464 Schoenherr Rd, Suite 160, Sterling Heights, MI 48312-6314 | 2009-10-05 |
| 1891989463 | Christine Collings Wybo | Physician Assistant | 35200 Dequindre Rd, Suite 100, Sterling Heights, MI 48310-4837 | 2007-08-28 |
| 1326170952 | Wendy K Howard | Physician Assistant | 5456 15 Mile Rd, Ste 101, Sterling Heights, MI 48310-5110 | 2007-03-09 |
| Find all providers in STERLING HEIGHTS | ||||
| City | STERLING HEIGHTS |
| Zip Code | 48313 |
Please comment or provide details below to improve the information on MR. BRENT CHARLES RUSSELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.