Healthcare Provider Details

I. General information

NPI: 1396327862
Provider Name (Legal Business Name): ALLISON ELLIS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON ABBOTT KIRCHNER

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PATRIOT BLVD
GLENVIEW IL
60026-8066
US

IV. Provider business mailing address

2701 PATRIOT BLVD
GLENVIEW IL
60026-8066
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7664
  • Fax: 847-998-9071
Mailing address:
  • Phone: 847-535-7665
  • Fax: 847-998-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036181263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: