Individual
THOMAS WILKS ELLIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A. C
Contact information
Practice address
12000 ELM CREEK BLVD N, SUITE 360, MAPLE GROVE, MN 55369-7073
(763) 315-4300
(763) 315-4360
Mailing address
2873 233RD LN NW, ST FRANCIS, MN 55070-8630
(763) 753-3306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9063
MN
Other
Enumeration date
06/02/2006
Last updated
09/24/2012
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