Provider Demographics
NPI:1386611259
Name:ELLIS, AARON R (MD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:R
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-4441
Mailing Address - Fax:810-385-1540
Practice Address - Street 1:4154 S RIVER RD
Practice Address - Street 2:BLDG 2
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2925
Practice Address - Country:US
Practice Address - Phone:810-329-2350
Practice Address - Fax:810-329-2695
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-04-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301046223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386611259Medicaid
MI1386611259Medicaid