Individual
MR. ERNEST EDWARD ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4400 W 95TH ST, SUITE 106, OAK LAWN, IL 60453-2654
(708) 422-7758
(708) 422-8154
Mailing address
4400 W 95TH ST, SUITE 106, OAK LAWN, IL 60453-2654
(708) 422-7758
(708) 422-8154
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085.002980
IL
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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