Provider Demographics
NPI:1326052382
Name:RUSSEAU TEAM HEALTHCARE, LTD.
Entity Type:Organization
Organization Name:RUSSEAU TEAM HEALTHCARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIBCN, DABFP
Authorized Official - Phone:630-690-4040
Mailing Address - Street 1:311 S NAPERVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5473
Mailing Address - Country:US
Mailing Address - Phone:630-690-4040
Mailing Address - Fax:
Practice Address - Street 1:311 S NAPERVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5473
Practice Address - Country:US
Practice Address - Phone:630-690-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL539590OtherPTAN
IL539590OtherPTAN