Middendorf, Ellen

Middendorf, Ellen is an individual health care provider with primary practice located at 4600 Memorial Dr Ste. 160, Belleville IL 62226-5368. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Middendorf, Ellen can be contacted via phone (618) 235-0460.

Contact Information

Primary practice address
4600 Memorial Dr Ste. 160 Belleville IL 62226-5368
Phone: (618) 235-0460
Fax: (618) 235-1464
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-108143 Illinois

Profile Details

NPI number 1245234988
LBN Legal business name Middendorf, Ellen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2005
Last updated May 24th, 2012 - about 12 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 1245234988 NPPES
Illinois MEDICAID 036108143
Illinois MEDICAID 1245234988

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