Provider Demographics
NPI:1518935022
Name:NORWOOD, RUSSELL W (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:NORWOOD
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 1:3300 BURR OAK AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-3802
Mailing Address - Country:US
Mailing Address - Phone:708-388-0423
Mailing Address - Fax:708-388-1477
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-385-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR111452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000690225OtherBCBS
KYP00928212OtherRR MEDICARE
KY7100017330Medicaid
KYP400036099Medicare PIN
KY000000690225OtherBCBS
KYP400036101Medicare PIN
MOE42134Medicare UPIN