Provider Demographics
NPI:1548701998
Name:FARR, ELLEN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:FARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 99TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4339
Mailing Address - Country:US
Mailing Address - Phone:414-805-3000
Mailing Address - Fax:414-955-0104
Practice Address - Street 1:601 N 99TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4339
Practice Address - Country:US
Practice Address - Phone:414-805-3000
Practice Address - Fax:414-955-0104
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1458421208100000X
WI84417208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0002318Medicaid
WI1548701998Medicaid