Carey Eugene Ellis
Family Doctor - Sports Medicine
400 S Kennedy Dr
Bradley
, Illinois 60915-2682
Carey Eugene Ellis
Family Doctor - Sports Medicine
400 S Kennedy Dr
Bradley
, Illinois 60915-2682
(815) 928-9858
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About
Features
Specialties
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Carey Eugene Ellis
- 400 S Kennedy Dr
- Bradley, IL
- Zip : 60915-2682
- Fax : (815) 928-9858
- Phone : (815) 928-8050
Second Address
- Carey Eugene Ellis
- 400 S Kennedy Dr
- Bradley, IL
- Zip : 60915-2682
- Fax : (815) 928-9858
- Phone : (815) 928-8050
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QS0010X | Family Doctor - Sports Medicine | 036-110022 | IL |
National Provider Identifier
| NPI | 1316955099 |
|---|---|
| Provider Name | Carey Eugene Ellis |
| First Address | Bradley, IL 60915-2682 |
| Second Address | Bradley, IL 60915-2682 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/08/2006 |
| Last Update Date | 06/04/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 36110022 | (05) | IL |
| H95995 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.