Provider Demographics
NPI:1104868181
Name:ZIAJA, ELLEN L (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:ZIAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 202
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3441
Mailing Address - Country:US
Mailing Address - Phone:262-241-5040
Mailing Address - Fax:262-251-5261
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-1800
Practice Address - Fax:414-649-5309
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI399522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32461100Medicaid
WI32461100Medicaid
000301331Medicare PIN
WI000307805Medicare PIN