Provider Demographics
NPI:1881908671
Name:LABEAU, RUSSELL FREDERICK JR
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:FREDERICK
Last Name:LABEAU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9602
Mailing Address - Country:US
Mailing Address - Phone:231-347-5682
Mailing Address - Fax:231-347-5682
Practice Address - Street 1:402 ROLLING HILLS LN
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9602
Practice Address - Country:US
Practice Address - Phone:231-347-5682
Practice Address - Fax:231-347-5682
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026523208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice