Mary Katherine Ellis, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

29428-020 Issued in WI

Practice address

915 Summit Ave
Oconomowoc, WI 53066-3994

Phone

(262) 569-2300

Fax

(262) 569-2266

NPI assigned

Aug 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Katherine Ellis-Metz Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1679688774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-647-6326",
            "fax_number": "414-671-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663994",
            "telephone_number": "262-569-2300",
            "fax_number": "262-569-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "29428-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31706000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "ELLIS-METZ",
            "middle_name": "KATHERINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gretchen Ekins
• Howard V. Elconin, M.D.
• Shayla Ellingboe
• Eric M Elliot, DMSC, PA-C
• Susan Corene Elliott, LPN
• Embrace Life Trauma Institute
• Colleen Englebert, R.PH.
• Karrie Lynn Erdman, OTR
• Rochelle Lois Ervin, LCSW
• Audrey Eshleman-Head, LPC-IT

• Ophthalmology Physician in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Ophthalmology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.