Provider Demographics
NPI:1043637150
Name:RUSSEAU, ANDREW P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:RUSSEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2845 N SHERIDAN RD STE 904
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6211
Mailing Address - Country:US
Mailing Address - Phone:773-326-2244
Mailing Address - Fax:
Practice Address - Street 1:2845 N SHERIDAN RD STE 904
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:773-326-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036148446208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery