Organization
MICHAEL R ELLEN MD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL R ELLEN MD (OWNER)
(360) 754-3380
Entity
Organization
Contact information
Practice address
128 LILLY RD NE, SUITE 205, OLYMPIA, WA 98506-5029
(360) 754-3380
Mailing address
128 LILLY RD NE, SUITE 205, OLYMPIA, WA 98506-5029
(360) 754-3380
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD00026526
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1105360
—
WA
Enumeration date
08/19/2006
Last updated
08/22/2020
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