Individual
KARISSA ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Mailing address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02004850A
IN
Other
Enumeration date
04/16/2012
Last updated
08/12/2016
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