Individual
STEVEN R ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 PENNSYLVANIA AVE, SUITE 104, OTTUMWA, IA 52501-6413
(641) 682-4594
(641) 682-2123
Mailing address
1005 PENNSYLVANIA AVE, SUITE 104, OTTUMWA, IA 52501-6413
(641) 682-4594
(641) 682-2123
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20730
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0159012
—
IA
01
—
110144445
RR MEDICARE
IA
05
—
1159012
—
IA
05
—
1740267723
—
IA
05
—
2159012
—
IA
Enumeration date
12/29/2005
Last updated
05/22/2012
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