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Individual

DR. ELLIS J TALBERT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7000 S ADAMS ST, SUITE 240, WILLOWBROOK, IL 60527-8453
(630) 986-5106
(630) 986-5119
Mailing address
7000 S ADAMS ST, SUITE 240, WILLOWBROOK, IL 60527-8453
(630) 986-5106
(630) 986-5119

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036076981
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
211174
PROVIDER NUMBER
IL
Enumeration date
10/11/2006
Last updated
05/10/2012
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