Individual
DR. JONATHAN J ELLICHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6401 POPLAR AVE STE 410, MEMPHIS, TN 38119-4808
(901) 259-2718
(901) 259-1123
Mailing address
1779 KIRBY PKWY # 1-511, MEMPHIS, TN 38138-3666
(901) 371-5218
(901) 682-1785
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
18972
MS
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
39618
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06336753
—
MS
05
—
165449001
—
AR
05
—
30005342
—
TN
Enumeration date
07/13/2006
Last updated
03/08/2016
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