Individual
DR. CHARLES NORMAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CTR RECP B, ANN ARBOR, MI 48109-5314
(734) 936-4054
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301039740
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1364958
—
MI
Enumeration date
10/04/2006
Last updated
03/01/2012
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