Ellichman, Jonathan J

Ellichman, Jonathan J is an sole proprietor health care provider with primary practice located at 6401 Poplar Ave Ste 410 , Memphis TN 38119-4808. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery). Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Ellichman, Jonathan J can be contacted via phone (901) 259-2718.

Contact Information

Primary practice address
6401 Poplar Ave Ste 410 Memphis TN 38119-4808
Phone: (901) 259-2718
Fax: (901) 259-1123
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 18972 Mississippi
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 39618 Tennessee

Profile Details

NPI number 1073538823
LBN Legal business name Ellichman, Jonathan J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 13th, 2006
Last updated Mar 8th, 2016 - about 9 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 1073538823 NPPES
Tennessee MEDICAID 30005342
Tennessee MEDICAID 165449001
Tennessee MEDICAID 06336753

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