Individual
ERIC ELLEBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5941
Mailing address
20 5TH ST SE, COOK, MN 55723-9702
(218) 666-5941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
62672
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2014
Last updated
06/30/2021
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