Individual
DR. ROBERT M. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1373 E SR 62, MADISON, IN 47250
(812) 801-0865
(812) 801-0775
Mailing address
PO BOX 3395, EVANSVILLE, IN 47732-3395
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01023029
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042192
ANTHEM BCBS
IN
01
—
080100605
MEDICARE RAILROAD
—
05
—
100148650A
—
IN
01
—
414646P
SIHO
IN
01
—
42192
ANTHEM
IN
01
—
4364752
AETNA
IN
01
—
4364752
AETNA
—
05
—
64759715
—
KY
Enumeration date
06/30/2006
Last updated
02/20/2019
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