| NPI | 1609893783 |
|---|---|
| Former Legal Business Name | SUSAN ELLIS, M.D. |
| Entity Type | Organization |
| Authorized Contact | SUSAN S ELLIS Owner President 719-471-4147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |