Individual
DR. JOHN C ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4880 NE GOODVIEW CIRCLE, LEES SUMMIT, MO 64064
(816) 478-4200
(816) 478-0507
Mailing address
3340 NE RALPH POWELL RD, SUITE B, LEES SUMMIT, MO 64064-2368
(816) 875-2599
(816) 875-2598
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R8E78
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008021
UHC
MO
01
—
11540041
BCBS OF KC
MO
01
—
204510882
CHAMPUS
MO
01
—
4001449
AETNA
MO
01
—
9852
BNDD
MO
Enumeration date
02/14/2006
Last updated
03/07/2023
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