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Dr. Richenel Samuel Ellecom

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NPI Number Detailed Information

Provider Information:

Name: Dr. Richenel Samuel Ellecom
Gender: M
Provider License Number If Given: 20040961A

NPI Information:

NPI: 1063406569
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 10/27/2008

Provider Business Mailing Address:

Address: 621 PLAINFIELD RD SUITE 110
Willow Brook, IL 60527
Phone Number: 6306541377
Fax Number: 6306542575

Provider Business Practice Location Address:

Address: 621 PLAINFIELD RD SUITE 110
Willow Brook, IL 60527
Phone Number: 6306541377
Fax Number: 6306542575

Provider Taxonomy:

Primary: 103G00000X
Secondary (if any): 103G00000X
State: IL

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