Provider Demographics
NPI:1346298676
Name:PELLAR, RUSSELL W (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:W
Last Name:PELLAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10110 DONALD POWERS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-922-0222
Mailing Address - Fax:219-922-8899
Practice Address - Street 1:10110 DONALD POWERS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-922-0222
Practice Address - Fax:219-922-8899
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-08-17
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Provider Licenses
StateLicense IDTaxonomies
IN01029020A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100200800Medicaid
INE14013Medicare UPIN
IN168090CMedicare ID - Type Unspecified