Individual
ELLEN SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(313) 533-5002
Mailing address
PO BOX 772290, DETROIT, MI 48277-2290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009218
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9111866
FL PA LICENSE
FL
Enumeration date
01/08/2019
Last updated
04/25/2024
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