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:
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184624819 | NPPES |
| Illinois | MEDICAID | 036077308 | |
| Illinois | MEDICAID | 200123470B |
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