MEDICARE: KAREN A ELLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G54822	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154315604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN A ELLIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2311
Second Line	:
City	:	CHATSWORTH
State	:	CA
Zip	:	91313-2311
Country	:	US
Telephone Number	:	818-718-9500
Fax Number	:	818-718-9507

Provider Business Practice Location Address
First Line	:	501 S BUENA VISTA ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4809
Country	:	US
Telephone Number	:	818-847-4422
Fax Number	:	818-847-4429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	10/02/2007

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