Individual
DR. ELLEN FERTELMEISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
PMS 8170 MC CORMICK BLVD, SUITE 204, SKOKIE, IL 60076-2920
(847) 410-2029
(847) 410-2041
Mailing address
8170 MC CORMICK BLVD, SUITE 204, SKOKIE, IL 60076-2920
(847) 410-2029
(847) 410-2041
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-071978
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-071978
MEDICAL LICENSE
IL
Enumeration date
12/18/2006
Last updated
07/08/2007
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