Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01025493A | IN |
NPI | 1023036530 |
---|---|
Provider Name | Robert K Ellis |
First Address | Elkhart, IN 46514-1228 |
Second Address | Elkhart, IN 46514-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 01/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100112110A | (05) | IN |
D95453 | (02) |