Dr. Marco Fredrick Ellis, M.D.

Plastic Surgery in Chicago, IL. Individual provider (NPI-1).

NPI number1508021171

StatusActive

Last updated in NPPESJun 21, 2023

Details

NPI: 1508021171
Entity type: Individual (NPI-1)
Name: Dr. Marco Fredrick Ellis
Credential: M.D.
Sex: Male
Sole proprietor: No
Enumeration date: Jul 23, 2008
Certification date: Jun 21, 2023
Last updated: Jun 21, 2023

Medicare and OIG

Medicare enrolled (PECOS): Yes · PRACTITIONER - PLASTIC AND RECONSTRUCTIVE SURGERY
Can order and refer: Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208200000X	Plastic Surgery	036121419	IL	Yes

Practice location

259 E Erie St Ste 20-2060
Chicago, IL 60611-2987

Phone 312-695-6022 · Fax 312-695-5672

Mailing address

259 E Erie St Ste 20-2060
Chicago, IL 60611-2987

Phone 312-695-6022 · Fax 312-695-5672

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Plastic Surgery Physician providers in Chicago, IL

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