Ellis, Shane Thomas

Ellis, Shane Thomas is an individual health care provider with primary practice located at 2925 Chicago Ave , Minneapolis MN 55407. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / General Practice, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Ellis, Shane Thomas can be contacted via phone (612) 863-4000.

Contact Information

Primary practice address
2925 Chicago Ave Minneapolis MN 55407
Phone: (612) 863-4000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 57547 Minnesota
Allopathic & Osteopathic Physicians / General Practice 208D00000X 57547 Minnesota
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1366701153
LBN Legal business name Ellis, Shane Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 14th, 2012
Last updated Mar 11th, 2021 - about 4 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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