Provider Demographics
NPI:1295741338
Name:RUSSELL, DEBORAH LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4177 FASHION SQUARE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-5216
Mailing Address - Country:US
Mailing Address - Phone:989-791-9100
Mailing Address - Fax:989-791-6746
Practice Address - Street 1:4177 FASHION SQUARE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-5216
Practice Address - Country:US
Practice Address - Phone:989-791-9100
Practice Address - Fax:989-791-6746
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053500207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3170069Medicaid
MI3170069Medicaid
MIE77745Medicare UPIN