Ellis, Leslie R
Ellis, Leslie R is an individual health care provider with primary practice located at 4123 Dutchmans Ln Ste 301 , Louisville KY 40207-4721. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, which is considered as his primary health care specialty. Ellis, Leslie R can be contacted via phone (502) 896-2500.Contact Information
Primary practice address
4123 Dutchmans Ln Ste 301
Louisville KY 40207-4721
Phone: (502) 896-2500
Fax: (502) 896-2527
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine | 2080N0001X | 35733 | Kentucky |
Profile Details
| NPI number | 1679542765 |
|---|---|
| LBN Legal business name | Ellis, Leslie R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 14th, 2006 |
| Last updated | Sep 14th, 2021 - about 3 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 | 1679542765 | NPPES |
| Kentucky | Other | 50035433 | PASSPORT- KCNS |
| Kentucky | MEDICAID | 64067267 | PASSPORT- KCNS |
| Kentucky | Other | 000000744501 | PASSPORT- KCNS |
| Kentucky | MEDICAID | 200439570 | PASSPORT- KCNS |
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