Provider Demographics
NPI:1801817242
Name:BIRD, RUSSELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5733
Practice Address - Street 1:2400 EASTPOINT PKWY
Practice Address - Street 2:SUITE 550
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-253-6630
Practice Address - Fax:502-253-6639
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000316211OtherANTHEM
KY64028491Medicaid
KYG32759Medicare UPIN
KY000000316211OtherANTHEM