Individual
CLAY ELLENWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.006802RX
OH
363AM0700X
Medical Physician Assistant
5601008913
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601008913
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
12/04/2018
Last updated
08/19/2022
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