Ellenby, Martin Ira

Ellenby, Martin Ira is an individual health care provider with primary practice located at 10258 Southwest Hwy Ste A , Chicago Ridge IL 60415-1361. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Ellenby, Martin Ira can be contacted via phone (708) 346-9533.

Contact Information

Primary practice address
10258 Southwest Hwy Ste A Chicago Ridge IL 60415-1361
Phone: (708) 346-9533
Fax: (708) 499-4312
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036077308 Illinois
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 036077308 Illinois

Profile Details

NPI number 1184624819
LBN Legal business name Ellenby, Martin Ira
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2005
Last updated Feb 21st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184624819 NPPES
Illinois MEDICAID 036077308
Illinois MEDICAID 200123470B

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