Individual
JULIUS RODNEY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACOG
Contact information
Practice address
1509 STATE ST, LA PORTE, IN 46350-3115
(219) 362-4690
(219) 362-4692
Mailing address
1509 STATE ST, LA PORTE, IN 46350-3115
(219) 362-4690
(219) 362-4692
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01052711A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522304
ANTHEM, BCBS
IN
05
—
200286860
—
IN
Enumeration date
08/07/2006
Last updated
09/16/2020
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