Individual
DR. JONATHAN ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-3794
(414) 266-1752
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-3794
(414) 266-1752
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301092616
MI
2088P0231X
Pediatric Urology Physician
Primary
69623
WI
2088P0231X
Pediatric Urology Physician
MD60449464
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861655581
—
WI
Enumeration date
07/02/2008
Last updated
06/13/2023
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