Provider Demographics
NPI:1265534697
Name:ELLIS, ROBERT FRANK (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANK
Last Name:ELLIS
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 1:770 ELYSIAN WAY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4500
Mailing Address - Country:US
Mailing Address - Phone:219-671-1154
Mailing Address - Fax:
Practice Address - Street 1:770 ELYSIAN WAY
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4500
Practice Address - Country:US
Practice Address - Phone:219-671-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028917A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology