Individual
JOHN P ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
21992 LORAIN RD, FAIRVIEW PARK, OH 44126-3333
(440) 333-7300
(440) 995-1234
Mailing address
21992 LORAIN RD, FAIRVIEW PARK, OH 44126-3333
(440) 333-7300
(440) 995-1234
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36002463E
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0691845
—
OH
Enumeration date
11/17/2006
Last updated
01/23/2015
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