Ellis, Mark L.

Ellis, Mark L. is an individual health care provider with primary practice located at 11995 Singletree Ln Ste 500 , Eden Prairie MN 55344-5349. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Other Service Providers / Specialist. Other Service Providers / Specialist is his primary health care specialty. Ellis, Mark L. can be contacted via phone (952) 595-1301.

Contact Information

Primary practice address
11995 Singletree Ln Ste 500 Eden Prairie MN 55344-5349
Phone: (952) 595-1301
Fax: (612) 294-4903
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 13170 Mississippi
Other Service Providers / Specialist 174400000X 13170 Mississippi

Profile Details

NPI number 1598791535
LBN Legal business name Ellis, Mark L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2006
Last updated Oct 2nd, 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 1598791535 NPPES
Mississippi MEDICAID 00112542
Mississippi Other 300124842

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