Individual
DR. MARCO FREDRICK ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
259 E ERIE ST STE 20-2060, CHICAGO, IL 60611-2987
(312) 695-6022
(312) 695-5672
Mailing address
259 E ERIE ST STE 20-2060, CHICAGO, IL 60611-2987
(312) 695-6022
(312) 695-5672
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036121419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12576013
CAQH
—
Enumeration date
07/23/2008
Last updated
06/21/2023
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