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General NPI Number Information
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NPI Number | 1598847642
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Entity Type | Organization
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Legal Business Name | DR. FREDRICK ELLYIN, LTD
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5140 N CALIFORNIA AVE SUITE 545
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City | CHICAGO
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State | IL
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Zip | 60625-3645
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Country | US
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Telephone | 773-275-0177
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Fax | 773-275-5431
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Provider Business Mailing Address
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Address Line | 5140 N CALIFORNIA AVE SUITE 545
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City | CHICAGO
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State | IL
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Zip | 60625-3645
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Country | US
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Telephone | 773-275-0177
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Fax | 773-275-5431
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDRICK M ELLYIN
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Credential | MD, FACP, FCP, FACE
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Telephone | 773-275-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State | IL
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