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1780785402

NPI Code Detail

MEDICARE: DR. DAVID L ELLENS MD

MEDICARE: DR. DAVID L ELLENS 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	207R00000X	Internal Medicine Physician	036088924	IL
2	207R00000X	Internal Medicine Physician	ME156236	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780785402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L ELLENS MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 E HWY 50 STE B
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5189
Country	:	US
Telephone Number	:	352-241-0549
Fax Number	:	352-242-9325

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/10/2025

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Directions to “ DR. DAVID L ELLENS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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