Dr. Fredrick Ellyin, LTD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

DR. FREDRICK ELLYIN, LTD

Practice address

5140 N California Ave
Suite 545
Chicago, IL 60625-3645

Phone

(773) 275-0177

Fax

(773) 275-5431

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Fredrick M Ellyin, MD, FACP, FCP, FACE

Title

Owner

Phone

(773) 275-0177

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1598847642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 545",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-275-0177",
            "fax_number": "773-275-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 N CALIFORNIA AVE",
            "address_2": "SUITE 545",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606253645",
            "telephone_number": "773-275-0177",
            "fax_number": "773-275-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. FREDRICK ELLYIN, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ELLYIN",
        "authorized_official_first_name": "FREDRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-275-0177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, FACP, FCP, FACE"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "21609026",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Chicago, IL by specialty
• Endocrinology, Diabetes & Metabolism Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.