Individual
DR. MICHAEL JOHN ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1595 SOQUEL DR STE 230, SANTA CRUZ, CA 95065-1721
(831) 226-3225
(831) 423-7579
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G64790
CA
207RP1001X
Pulmonary Disease Physician
Primary
G64790
CA
Other
Enumeration date
02/09/2006
Last updated
08/20/2023
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