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General NPI Number Information
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NPI Number | 1235661117
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Entity Type | Individual
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Provider Name | MICHAEL A ELLERMAN DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 640 JACKSON ST
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City | SAINT PAUL
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State | MN
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Zip | 55101-2502
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Country | US
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Telephone | 651-254-4887
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 W WISCONSIN AVE STE 300
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-6000
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Fax | 414-805-6280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 81478
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 79916
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License Number State | MN
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