MEDICARE: ELLIS NAM MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	036-106737	IL

General Provider Information

NPI Number	:	1316916190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIS NAM MD

Provider Business Mailing Address
First Line	:	900 RAND RD STE 300
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:	847-929-1154

Provider Business Practice Location Address
First Line	:	3000 HALSTED STREET
Second Line	:	SUITE 525
City	:	CHICAGO
State	:	IL
Zip	:	60657-9269
Country	:	US
Telephone Number	:	773-433-3130
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	11/29/2024

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Directions to “ ELLIS NAM MD” Practice Location

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