Grand Old Docs of the Southside

NPI #1790886844 in Greenwood, Indiana

Provider Information

NPI Number: 1790886844
Entity Type: Organization
Organization Name: Grand Old Docs of the Southside
Primary Specialty: Family Medicine
Enumeration Date: Sep 25, 2006
Last Updated: Jun 30, 2008

Practice Location

Address: 360 S MADISON AVE
Address 2: #200
City: Greenwood
State: Indiana
ZIP Code: 46142-3150
Phone: (317) 865-9090

Authorized Official

Name: BRENDA R RUSSELL, MD
Title: PHYSICIAN
Phone: (317) 865-9090

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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