Ellis, Marco Fredrick
Ellis, Marco Fredrick is an individual health care provider with primary practice located at 259 E Erie St Ste 20-2060 , Chicago IL 60611-2987. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Ellis, Marco Fredrick can be contacted via phone (312) 695-6022.Contact Information
Primary practice address
259 E Erie St Ste 20-2060
Chicago IL 60611-2987
Phone: (312) 695-6022
Fax: (312) 695-5672
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | 036121419 | Illinois |
Profile Details
NPI number | 1508021171 |
---|---|
LBN Legal business name | Ellis, Marco Fredrick |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 23rd, 2008 |
Last updated | Jun 21st, 2023 - about last year |
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 | 1508021171 | NPPES |
Other | 12576013 | CAQH |
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