Dr. Jonathan J Ellichman
Vascular Surgeon Cardiothoracic Vascular Surgeon
6401 Poplar Ave Ste 410
Memphis
, Tennessee 38119-4808
Dr. Jonathan J Ellichman
Vascular Surgeon Cardiothoracic Vascular Surgeon
6401 Poplar Ave Ste 410
Memphis
, Tennessee 38119-4808
(901) 682-1785
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About
Features
Specialties
- Vascular Surgeon
- Cardiothoracic Vascular Surgeon
Languages spoken
- English
Location
First Address
- Dr. Jonathan J Ellichman
- 1779 Kirby Pkwy # 1-511
- Memphis, TN
- Zip : 38138-3666
- Fax : (901) 682-1785
- Phone : (901) 371-5218
Second Address
- Dr. Jonathan J Ellichman
- 6401 Poplar Ave Ste 410
- Memphis, TN
- Zip : 38119-4808
- Fax : (901) 259-1123
- Phone : (901) 259-2718
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0129X | Vascular Surgeon | 18972 | MS |
| N | 208G00000X | Cardiothoracic Vascular Surgeon | 39618 | TN |
National Provider Identifier
| NPI | 1073538823 |
|---|---|
| Provider Name | Dr. Jonathan J Ellichman |
| First Address | Memphis, TN 38138-3666 |
| Second Address | Memphis, TN 38119-4808 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/07/2006 |
| Last Update Date | 08/03/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 06336753 | (05) | MS |
| 165449001 | (05) | AR |
| 30005342 | (05) | TN |
| I49075 | (02) | TN |
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.