| Robert E Ellis Md | |
|
9115 Leesgate Rd Suite C Louisville KY 40222-5003 | |
| (502) 719-0782 | |
| (502) 719-0787 |
| Full Name | Robert E Ellis Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 9115 Leesgate Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Robert E Ellis (PRESIDENT) |
| Authorized Official Contact | 5027190782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert E Ellis Md 9115 Leesgate Rd Suite C Louisville KY 40222-5003 Ph: (502) 719-0782 | Robert E Ellis Md 9115 Leesgate Rd Suite C Louisville KY 40222-5003 Ph: (502) 719-0782 |
| NPI Number | 1154465276 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/13/2009 |
| Medicare PECOS PAC ID | 4880630078 |
|---|---|
| Medicare Enrollment ID | O20050628000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154465276 | NPI | - | NPPES |
| 1172028 | Other | KY | PASSPORT HEALTH PLAN |
| 2441036000 | Other | KY | PASSPORT ADVANTAGE |
| CH0800 | Other | KY | MEDICARE RR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 19194 (Kentucky) | Primary |
| Provider Name | Robert E Ellis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427006816 PECOS PAC ID: 0941246136 Enrollment ID: I20110216000073 |
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