Most Relevant Information
Provider Data
| NPI Number: | 1003567074 |
| Provider Name: | MARCUS AYINDE ELLINGTON |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/12/2022 |
| Last Updated: | 01/12/2022 |
Provider Practice Location
701 E 17TH ST
BLOOMINGTON
IN
474081578
Practice Location Phone/Fax
| Phone: | 3172708973 |
| Fax: |
Provider Mailing Location
628 W 17TH ST
BLOOMINGTON
IN
474043460
Provider Mailing Phone/Fax
| Phone: | 3172708973 |
| Fax: |