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:
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Health care specialties

SpecialtyCodeLicense #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 2 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 1508021171 NPPES
Other 12576013 CAQH

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