Provider Demographics
NPI:1043219496
Name:RUSSELL, TODD E (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-2003
Mailing Address - Fax:419-479-6977
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:SUITE 450
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-2003
Practice Address - Fax:419-479-6977
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350746262086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000493404OtherANTHEM
OH03444OtherPARAMOUNT
OH5773778OtherAETNA
OH21-01841OtherUHC
OH2215678Medicaid
MI4957870Medicaid
OH10221OtherHEALTH PLAN OF MI
OHP00366278OtherRRMC
OHP00366278OtherRRMC
OHG94647Medicare UPIN
OH000000493404OtherANTHEM