Healthcare Provider Details

I. General information

NPI: 1720382393
Provider Name (Legal Business Name): MICHAEL JOSEPH ELLISON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 N HIGHWAY 65
LINDSAY CA
93247-2702
US

IV. Provider business mailing address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-525-9097
  • Fax:
Mailing address:
  • Phone: 559-781-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21345
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: