Individual
DR. MARY KATHERINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
915 SUMMIT AVE, OCONOMOWOC, WI 53066-3994
(262) 569-2300
(262) 569-2266
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
29428-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31706000
—
WI
Enumeration date
08/20/2006
Last updated
03/07/2023
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