Individual
DR. MARY KATHRYN ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6572
Mailing address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6572
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
39682-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34074200
—
WI
01
—
P00202747
RAILROAD MEDICARE
WI
Enumeration date
05/11/2006
Last updated
07/08/2007
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