Basic Information
| Provider Information | |||||||||
| NPI: | 1275526667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YALE | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100-15TH AVE. | ||||||||
| Address2: | #180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147446589 | ||||||||
| FaxNumber: | 4147644307 | ||||||||
| Practice Location | |||||||||
| Address1: | 10520 N. PORT WASHINGTON RD. | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622400705 | ||||||||
| FaxNumber: | 2622400759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 22241-20 | WI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.