Individual
MICHELLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D..
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 731-8900
(920) 738-5369
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 830-5900
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
4301100710
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
51276
MT
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
56534
TN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
67697-20
WI
Other
Enumeration date
05/31/2007
Last updated
10/08/2024
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