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Mark L. Ellis, MD
Specialist in Eden Prairie, Minnesota
NPI 1598791535

Mark L. Ellis is a Specialist based in Columbus, MN. Mark L. Ellis practices in Eden Prairie, MN and has the professional credentials of MD. The NPI Number for Mark L. Ellis is 1598791535 and holds a License No. 13170 (Minnesota).

The current practice location address for Mark L. Ellis is 11995 Singletree Ln Ste 500, Eden Prairie, MN and can be reached out via phone at 952-595-1301 and via fax at 612-294-4903. You can also correspond with Mark L. Ellis through the mailing address at PO BOX 7695, COLUMBUS, MS - 39705-0026 (mailing address contact number: 662-328-2476).

Location: 11995 Singletree Ln Ste 500, Eden Prairie, MN, 39705-0026
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Provider Profile Details
NPI Number
1598791535
Provider Name
Mark L. Ellis
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
11995 Singletree Ln Ste 500, Eden Prairie, MN, 39705-0026
Phone Number
952-595-1301
Fax Number
612-294-4903
Provider Enumeration Date
06/23/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00112542 05 MS
300124842 01 MS RAIL ROAD MEDICARE
institution
Provider Business Practice Location Address Details
Address
11995 Singletree Ln Ste 500
City
State
Zip
55344-5349
Phone Number
952-595-1301
Fax Number
612-294-4903
person
Provider Business Mailing Address Details
Address
11995 Singletree Ln Ste 500
City
State
Zip
55344-5349
Phone Number
952-595-1301
Fax Number
612-294-4903
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
License No.
13170 (Mississippi)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
License No.
13170 (Mississippi)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
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