Provider Demographics
NPI:1245226711
Name:EMBRY, ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:EMBRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OGDEN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7205
Mailing Address - Country:US
Mailing Address - Phone:630-978-6886
Mailing Address - Fax:630-978-6806
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4700
Practice Address - Country:US
Practice Address - Phone:630-978-6886
Practice Address - Fax:630-978-6806
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087762207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L97439Medicare ID - Type Unspecified
E43806Medicare UPIN