Individual
BRANDON D ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 364-6700
Mailing address
PO BOX 1629, LIMA, OH 45802-1629
(877) 378-4293
(419) 223-2726
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301102483
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689848459
—
MI
Enumeration date
04/14/2008
Last updated
07/14/2021
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