Ellis, Walter Nicholas

Ellis, Walter Nicholas is an sole proprietor health care provider with primary practice located at 106 Doctors Park , St Cloud MN 56303-1207. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Ellis, Walter Nicholas can be contacted via phone (320) 251-5444.

Contact Information

Primary practice address
106 Doctors Park St Cloud MN 56303-1207
Phone: (320) 251-5444
Fax: (320) 656-9590
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 451 Minnesota

Profile Details

NPI number 1588625958
LBN Legal business name Ellis, Walter Nicholas
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 28th, 2006
Last updated Jan 8th, 2015 - about 9 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 1588625958 NPPES
Minnesota MEDICAID 684025600

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