Provider Demographics
NPI:1275526667
Name:YALE, RUSSELL STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:STEVEN
Last Name:YALE
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 1:100-15TH AVE.
Mailing Address - Street 2:#180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-744-6589
Mailing Address - Fax:414-764-4307
Practice Address - Street 1:10520 N. PORT WASHINGTON RD.
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-240-0705
Practice Address - Fax:262-240-0759
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22241-20207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02120-0229Medicare PIN