MEDICARE: ELLEN MIDDENDORF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-108143	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245234988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MIDDENDORF MD

Provider Business Mailing Address
First Line	:	4600 MEMORIAL DR
Second Line	:	STE. 160
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5368
Country	:	US
Telephone Number	:	618-235-0460
Fax Number	:	618-235-1464

Provider Business Practice Location Address
First Line	:	4600 MEMORIAL DR
Second Line	:	STE. 160
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5368
Country	:	US
Telephone Number	:	618-235-0460
Fax Number	:	618-235-1464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/24/2012

Similar Medicare Providers

1245236884 — NIDAL SHAWAHIN MD
Practice Location Address:

4600 MEMORIAL DR , STE. 360
BELLEVILLE, IL
62226-5368

Practice Phone: 618-222-7280
Practice Fax: 618-222-7281

1669466066 — DR. BRIAN A ONEILL MD
Practice Location Address:

4600 MEMORIAL DR , STE. 220
BELLEVILLE, IL
62226-5368

Practice Phone: 618-235-6191
Practice Fax: 618-235-6716

1417937574 — ANNE MARGARET CATH MD
Practice Location Address:

4600 MEMORIAL DR , STE. 440
BELLEVILLE, IL
62226-5368

Practice Phone: 618-236-8000
Practice Fax: 618-236-8005

1003873647 — CINDY L. AULD FNP
Practice Location Address:

4600 MEMORIAL DR , STE. 400
BELLEVILLE, IL
62226-5368

Practice Phone: 618-234-2390
Practice Fax: 618-234-9936

1720174246 — WILMAN ORTEGA PEREZ M.D.
Practice Location Address:

4600 MEMORIAL DR , STE. 200
BELLEVILLE, IL
62226-5368

Practice Phone: 618-233-2220
Practice Fax: 618-233-2555

1770735219 — EMILY MADELYN HOLLENKAMP RN, CPNP
Practice Location Address:

4600 MEMORIAL DR STE G60
BELLEVILLE, IL
62226-5368

Practice Phone: 618-257-2550
Practice Fax: 618-257-2569

Directions to “ ELLEN MIDDENDORF MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.