Provider Demographics
NPI:1619081155
Name:ELLISON, PATRICK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1329 LUSITANA ST 501
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2412
Mailing Address - Country:US
Mailing Address - Phone:808-521-1102
Mailing Address - Fax:808-521-1103
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-827-9548
Practice Address - Fax:813-828-5731
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-10-26
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Provider Licenses
StateLicense IDTaxonomies
HIMD-18276207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery