Individual
DR. BRANDON LEE ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MSC
Contact information
Practice address
251 EAST HURON STREET, CHICAGO, IL 60611
(312) 926-2000
Mailing address
251 EAST HURON STREET, CHICAGO, IL 60611
(312) 926-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1053014829
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2023
Last updated
05/24/2023
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