Russell Frederick Labeau Jr.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4301026523 Issued in MI

Practice address

402 Rolling Hills LN
Petoskey, MI 49770-9602

Phone

(231) 347-5682

Fax

(231) 347-5682

NPI assigned

Aug 4, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280880000000",
    "number": "1881908671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 ROLLING HILLS LN",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709602",
            "telephone_number": "231-347-5682",
            "fax_number": "231-347-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 ROLLING HILLS LN",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709602",
            "telephone_number": "231-347-5682",
            "fax_number": "231-347-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABEAU",
        "first_name": "RUSSELL",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-04",
        "last_updated": "2010-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301026523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.