Michael R Ellen MD PS

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD00026526 Issued in WA

Legal business name

MICHAEL R ELLEN MD PS

Practice address

128 Lilly Rd NE
Suite 205
Olympia, WA 98506-5029

Phone

(360) 754-3380

NPI assigned

Aug 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael R Ellen, MD

Title

Owner

Phone

(360) 754-3380

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174637599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE",
            "address_2": "SUITE 205",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065029",
            "telephone_number": "360-754-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LILLY RD NE",
            "address_2": "SUITE 205",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065029",
            "telephone_number": "360-754-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R ELLEN MD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-754-3380",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00026526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1105360",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney An Meyers
• MHG Physician Services - Washington, PLLC
• Jin S Miao, DMD
• Mica Homes
• Michael D Moore OD PS Inc
• Michael R Kelson, DDS, PLLC
• Michael W. Neely, D.C.
• Gina J Michaelson, L.M.P.
• Michelle Rubbert, PLLC
• Michelle Schuyleman Counseling

• Urology Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.