Individual
THEODORE ELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-7600
Mailing address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-7600
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036058013
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036058013
STATE LICENSE
IL
Enumeration date
06/20/2006
Last updated
01/26/2010
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