Ellis, Mary Kathryn
Ellis, Mary Kathryn is an individual health care provider with primary practice located at 2900 W Oklahoma Ave , Milwaukee WI 53215-4330. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as her primary health care specialty. Ellis, Mary Kathryn can be contacted via phone (414) 649-6572.Contact Information
Primary practice address
2900 W Oklahoma Ave
Milwaukee WI 53215-4330
Phone: (414) 649-6572
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 39682-020 | Wisconsin |
Profile Details
| NPI number | 1962452706 |
|---|---|
| LBN Legal business name | Ellis, Mary Kathryn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 11th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1962452706 | NPPES |
| Wisconsin | MEDICAID | 34074200 | |
| Wisconsin | Other | P00202747 |
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