Provider Demographics
NPI:1497994784
Name:RUSSELL, HYDE M (MD)
Entity Type:Individual
Prefix:DR
First Name:HYDE
Middle Name:M
Last Name:RUSSELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:WALGREEN SUITE 3507
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2868
Mailing Address - Fax:847-733-5005
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:WALGREEN SUITE 3507
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2868
Practice Address - Fax:847-733-5005
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2021-03-30
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Provider Licenses
StateLicense IDTaxonomies
IL036-108346208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)