Gustafson, Ellen J

Gustafson, Ellen J is an individual health care provider with primary practice located at 2614 W Jefferson St , Joliet IL 60435. She recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as her primary health care specialty. Gustafson, Ellen J can be contacted via phone (815) 725-1355.

Contact Information

Primary practice address
2614 W Jefferson St Joliet IL 60435
Phone: (815) 725-1355
Fax: (815) 725-9857
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 036109139 Illinois

Profile Details

NPI number 1245296896
LBN Legal business name Gustafson, Ellen J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 24th, 2006
Last updated Jun 17th, 2022 - 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 1245296896 NPPES
Illinois Other P00307129 MEDICARE RR
Illinois Other K26698 MEDICARE RR
Illinois Other K26699 MEDICARE RR
Illinois MEDICAID 036109139 MEDICARE RR
Illinois Other K26697 MEDICARE RR

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