Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0000521 | MN |
Y | 222Z00000X | Podiatrist | 0000521 | MN |
N | 213EP1101X | Primary Podiatric Medicine | 0000521 | MN |
NPI | 1548230311 |
---|---|
Provider Name | Martin Gerard Ellman |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 24/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U33083 | (02) | MN |