Individual
DONALD ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5939 N HURON RD, OSCODA, MI 48750-9710
(989) 739-1441
(989) 739-6093
Mailing address
PO BOX 779, TAWAS CITY, MI 48764-0779
(989) 739-1441
(989) 739-6093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301070492
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4209088
—
MI
Enumeration date
08/03/2006
Last updated
02/23/2023
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