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NPI Code Detail

MEDICARE: JAMIE ELLINGWOOD PA

MEDICARE: JAMIE ELLINGWOOD PA
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
1363A00000XPhysician Assistant085.004875IL

General Provider Information

NPI Number : 1952544488
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE ELLINGWOOD PA
Provider Business Mailing Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-751-7850
Fax Number : 773-338-4049
Provider Business Practice Location Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-751-7850
Fax Number : 773-338-4049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2009
Last Update Date : 09/05/2014

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Directions to “ JAMIE ELLINGWOOD PA” Practice Location

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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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