Individual
DOUGLAS R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1002 MEDICAL CENTER DR, FAMILY MEDICINE, MONTICELLO, IL 61856-2116
(217) 762-2518
(217) 762-5261
Mailing address
PO BOX 6002, URBANA, IL 61803-6002
(217) 326-8630
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-081822
IL
Other
Enumeration date
09/17/2005
Last updated
04/24/2013
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