Individual
CHARLES PAUL ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7057 N CLIO RD, MOUNT MORRIS, MI 48458-8261
(810) 670-0200
(810) 670-0196
Mailing address
3495 S CENTER RD, BURTON, MI 48519-1455
(810) 424-2011
(810) 249-4037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101015196
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080G310660
BLUE CARE NETWORK OF MICHIGAN
MI
01
—
080G3610660
MICHIGAN BLUE CROSS BLUE SHIELD
MI
01
—
0992950
HEALTH PLUS OF MICHIGAN
MI
01
—
1051020
MCLAREN HEALTH PLAN
MO
01
—
1780786707
MOLINA HEALTHCARE OF MICHIGAN
MN
05
—
1780786707
—
MI
01
—
178241
GREAT LAKES HEALTH PLAN/UNITED HEALTHCARE
MN
01
—
19870
HEALTH PLAN OF MICHIGAN
MI
01
—
381908328
HCAP
MI
01
—
381908328-446
CARE SOURCE OF MICHIGAN
MN
Enumeration date
09/01/2006
Last updated
12/09/2014
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