ANDREA MARTHA ELLIS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

First Name

ANDREA

Middle

MARTHA

Last Name

ELLIS

Suffix

Business Name

ANDREA MARTHA ELLIS MD

Original Issue Date

02/01/2007

Effective Date

07/13/2023

Expiration Date

07/31/2026

City

FORT WAYNE

State

Zip

46814

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/13/2023