Provider Demographics
NPI:1649231028
Name:ZUSSMAN, ELLIS B (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:B
Last Name:ZUSSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2033
Mailing Address - Country:US
Mailing Address - Phone:414-351-1359
Mailing Address - Fax:
Practice Address - Street 1:7220 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2054
Practice Address - Country:US
Practice Address - Phone:414-464-4888
Practice Address - Fax:414-464-1850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16653208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30030500Medicaid
WI30030500Medicaid