Provider Demographics
NPI:1710914478
Name:ELLWEIN, MARC H (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:H
Last Name:ELLWEIN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0998
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:2100 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3646
Practice Address - Country:US
Practice Address - Phone:605-322-5180
Practice Address - Fax:605-322-5179
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD0178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant