MEDICARE: DR. EDWARD L. EBERT DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	49828	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285604850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD L. EBERT DO

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 CTY HWY I
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-1423
Country	:	US
Telephone Number	:	715-726-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/17/2011

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