Individual
JODY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
901 MACARTHUR BLVD, RADIOLOGY DEPARTMENT, MUNSTER, IN 46321-2901
(219) 836-4569
Mailing address
9201 CALUMET AVE, MUNSTER, IN 46321-2807
(219) 836-2022
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1000818A
IN
Other
Enumeration date
04/14/2006
Last updated
03/18/2008
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