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NPI Code Detail

MEDICARE: ROBERT VICTOR ELLIS II M.D.

MEDICARE: ROBERT VICTOR ELLIS II M.D.
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
1207Q00000XFamily Medicine Physician35-084944OH

Other Identifiers

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

General Provider Information

NPI Number : 1548245731
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT VICTOR ELLIS II M.D.
Provider Business Mailing Address
First Line : PO BOX 636256 CENTRAL CREDENTIALING
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-6356
Country : US
Telephone Number : 513-585-5501
Fax Number : 513-585-5511
Provider Business Practice Location Address
First Line : 305 CRESCENT AVE
Second Line : UNIVERSITY WYOMING FAMILY PRACTICE CENTER
City : CINCINNATI
State : OH
Zip : 45215-4406
Country : US
Telephone Number : 513-821-0275
Fax Number : 513-821-3621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 01/10/2018

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