Ellsworth, Brandon D

Ellsworth, Brandon D is an individual health care provider with primary practice located at 200 Jefferson Ave Se , Grand Rapids MI 49503-4502. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Ellsworth, Brandon D can be contacted via phone (616) 364-6700.

Contact Information

Primary practice address
200 Jefferson Ave Se Grand Rapids MI 49503-4502
Phone: (616) 364-6700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 4301102483 Michigan

Profile Details

NPI number 1689848459
LBN Legal business name Ellsworth, Brandon D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2008
Last updated Jul 14th, 2021 - about 3 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 1689848459 NPPES
Michigan MEDICAID 1689848459

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