Search › Illinois › 101YM0800X
Kermit Ellison
NPI 1013354463 · on the registry since 2013 · sole proprietor
Practice
- Address
- 1240 Bamburg Ct
Hanover Park, IL 60133 - Phone
- (630) 372-6599
- Fax
- (630) 372-6697
- Clinicians at this address
- 7
Registry record
- Primary taxonomy
- 101YM0800X
101YM0800X
- Also registered as
- 101YS0200X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2013-05-24
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois