MEDICARE: PAUL ANDREW EKBERG 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	2084P0800X	Psychiatry Physician	38807	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H400378386	OTHER	MN	ACP MEDICARE

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

General Provider Information

NPI Number	:	1477531960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANDREW EKBERG DO

Provider Business Mailing Address
First Line	:	4240 PARK GLEN RD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-5427
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

Provider Business Practice Location Address
First Line	:	4027 COUNTY ROAD 25
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/28/2018

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