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General NPI Number Information
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NPI Number | 1114107976
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Entity Type | Organization
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Legal Business Name | ELLIS J TALBERT, MD SC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 7000 S ADAMS ST SUITE 240
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City | WILLOWBROOK
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State | IL
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Zip | 60527-8453
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Country | US
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Telephone | 630-986-5106
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Fax | 630-986-5119
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Provider Business Mailing Address
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Address Line | 7000 S ADAMS ST SUITE 240
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City | WILLOWBROOK
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State | IL
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Zip | 60527-8453
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Country | US
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Telephone | 630-986-5106
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Fax | 630-986-5119
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLIS JAY TALBERT
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Credential | MD
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Telephone | 630-986-5106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036076981
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License Number State | IL
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