Provider Demographics
NPI:1376898122
Name:CHRISTIAN, ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SE HILLMOOR DR STE 407
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7561
Mailing Address - Country:US
Mailing Address - Phone:772-335-9600
Mailing Address - Fax:772-398-7971
Practice Address - Street 1:1300 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4884
Practice Address - Country:US
Practice Address - Phone:772-302-3977
Practice Address - Fax:772-673-8502
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125061363207R00000X
FLME139552207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease