Provider Demographics
NPI:1407868722
Name:PIKUS, RUSSELL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JAMES
Last Name:PIKUS
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 1:225 S PINE ST JMB 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-523-4860
Mailing Address - Fax:812-523-4839
Practice Address - Street 1:225 S PINE ST JMB 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274
Practice Address - Country:US
Practice Address - Phone:812-523-4860
Practice Address - Fax:812-523-4839
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040449A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100342730Medicaid
IN00000092496OtherANTHEM
IN200490AMedicare ID - Type Unspecified
F39637Medicare UPIN