Charles L Ellis (NPI# 1013098698, PAC ID# 7911058524) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORAL SURGERY.
| Nation Provider ID (NPI) | 1013098698 |
| PAC ID by PECOS | 7911058524 |
| Professional Enrollment ID | I20151209001002 |
| Full Name | Charles L Ellis |
| Organization Legal Name | BAY ORAL SURGERY AND IMPLANT CENTER, LTD |
| Address |
2353 S Ridge Rd Suite 1 Green Bay WI 54304-5083 |
| Phone Number | 9204990471 |
| Gender | M |
| Medical School | UNIV OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY |
| Graduation Year | 1990 |
| Primary Specialty | ORAL SURGERY |
| Secondary Specialties | MAXILLOFACIAL SURGERY |
| Group Practice PAC ID | 0446274708 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 520097 | ST MARY'S HOSPITAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 | 9204990471 | BAY ORAL SURGERY AND IMPLANT CENTER, LTD |
| Organization Legal Name | BAY ORAL SURGERY AND IMPLANT CENTER, LTD |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bradley S Koch | Maxillofacial Surgery | Bay Oral Surgery and Implant Center, Ltd | 2007 Marinette Ave, Marinette, WI 54143-3864 |
| Reda Taleb | Oral Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| Jason L Lemoine | Maxillofacial Surgery | Bay Oral Surgery and Implant Center, Ltd | 2007 Marinette Ave, Marinette, WI 54143-3864 |
| Vijay S Parmar | Oral Surgery | Bay Oral Surgery and Implant Center, Ltd | 2007 Marinette Ave, Marinette, WI 54143-3864 |
| Michael J Miskella | Oral Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| David L Lemoine | Maxillofacial Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| Street Address |
2353 S RIDGE RD SUITE 1 |
| City | GREEN BAY |
| State | WI |
| Zip | 54304-5083 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Reda Taleb | Oral Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| Michael J Miskella | Oral Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| David L Lemoine | Maxillofacial Surgery | Bay Oral Surgery and Implant Center, Ltd | 2353 S Ridge Rd, Suite 1, Green Bay, WI 54304-5083 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael P Sayers | Psychologist, Clinical | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Rebecca M Krueger | Clinical Social Worker | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Sangita A Patel | Psychiatry | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Veeranagouda A Patil | Psychiatry | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Eusebio G Hernandez | Psychiatry | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Rhonda K Huhtala | Clinical Social Worker | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Mary Beth King | Clinical Social Worker | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| David M Danby | Family Medicine | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Monique L Gore | Clinical Social Worker | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Lisa Shaw | Clinical Social Worker | Oneida Nation | 2640 W Point Rd, Green Bay, WI 54304-1344 |
| Find all physicians in zip 54304 | |||
| City | GREEN BAY |
| Zip Code | 54304 |
| Specialty | ORAL SURGERY |
| City + Specialty | GREEN BAY + ORAL SURGERY |
Please comment or provide details below to improve the information on Charles L Ellis.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.