Provider Demographics
NPI:1619218971
Name:ELLWOOD, ROBERT ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARTHUR
Last Name:ELLWOOD
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 1:20046 RONSDALE DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3856
Mailing Address - Country:US
Mailing Address - Phone:248-644-6261
Mailing Address - Fax:
Practice Address - Street 1:20046 RONSDALE DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3856
Practice Address - Country:US
Practice Address - Phone:248-644-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034008208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice