Individual
DR. ELLEN L BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC GASTROENTEROLOGY, MILWAUKEE, WI 53226-4874
(414) 266-3690
(414) 266-3676
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC GASTROENTEROLOGY, MILWAUKEE, WI 53226-4874
(414) 266-3690
(414) 266-3676
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
22293
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008006261Q
HUMANA
—
05
—
1801847249
—
WI
Enumeration date
05/12/2006
Last updated
02/01/2013
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