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General NPI Number Information
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NPI Number | 1609030550
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Entity Type | Individual
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Provider Name | MALINDA ELLIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1634 E 63RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64110-3502
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Country | US
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Telephone | 816-381-5648
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Fax | 816-281-1871
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Provider Business Mailing Address
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Address Line | PO BOX 740019
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City | ATLANTA
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State | GA
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Zip | 30374-0019
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9407063
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2012003980
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License Number State | MO
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