Individual
IRA KEITH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2084 W MAIN ST, MILAN, TN 38358-3515
(615) 673-6737
Mailing address
294 SUMMAR DR, DEPT 289, JACKSON, TN 38301-3915
(731) 423-1932
(731) 410-0367
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38294
TN
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
38294
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166981
UNISON
TN
01
—
34018
TLC
TN
05
—
3823013
—
TN
05
—
3895527
—
TN
01
—
4101718
BLUE CROSS BLUE SHIELD
TN
01
—
4124210
BCBS
—
01
—
5657408
CIGNA
TN
01
—
626001636
UNITED HEALTHCARE
TN
01
—
P00277818
RAILROAD MEDICARE
TN
Enumeration date
06/30/2005
Last updated
01/10/2024
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