Individual
DR. ANDREW JAMES ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01078376
IN
208000000X
Pediatrics Physician
Primary
2018012696
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11017649A
STATE MEDICAL LICENSE
IN
Enumeration date
05/29/2014
Last updated
09/19/2022
Update your record
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