Organization
ROBERT E ELLIS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT E ELLIS M.D. (PRESIDENT)
(502) 719-0782
Entity
Organization
Contact information
Practice address
9115 LEESGATE RD, SUITE C, LOUISVILLE, KY 40222-5003
(502) 719-0782
(502) 719-0787
Mailing address
9115 LEESGATE RD, SUITE C, LOUISVILLE, KY 40222-5003
(502) 719-0782
(502) 719-0787
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19194
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172028
PASSPORT HEALTH PLAN
KY
01
—
2441036000
PASSPORT ADVANTAGE
KY
01
—
CH0800
MEDICARE RR
KY
Enumeration date
02/20/2007
Last updated
08/13/2009
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