Provider Demographics
NPI:1588756712
Name:TOTH-RUSSELL, PAULA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:TOTH-RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:611 E DOUGLAS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-472-6700
Practice Address - Fax:574-335-0643
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042736A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100467060AMedicaid
IN100467060Medicaid
IN000000721959OtherBCBS
IN100467060AMedicaid
INM400052327Medicare PIN
INP01008780Medicare PIN
INM400052327Medicare PIN