Organization
DR. FREDRICK ELLYIN, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDRICK M ELLYIN MD, FACP, FCP, FACE (OWNER)
(773) 275-0177
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE, SUITE 545, CHICAGO, IL 60625-3645
(773) 275-0177
(773) 275-5431
Mailing address
5140 N CALIFORNIA AVE, SUITE 545, CHICAGO, IL 60625-3645
(773) 275-0177
(773) 275-5431
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21609026
BLUE SHIELD PROVIDER #
IL
Enumeration date
10/19/2006
Last updated
04/20/2008
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