MEDICARE: SUDESH J EBENEZER MD, ED.M., FRCSC

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	207T00000X	Neurological Surgery Physician	036175459	IL
2	207T00000X	Neurological Surgery Physician	4301099586	MI

General Provider Information

NPI Number	:	1508824525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDESH J EBENEZER MD, ED.M., FRCSC

Provider Business Mailing Address
First Line	:	4800 S SAGINAW ST
Second Line	:	SUITE 1800
City	:	FLINT
State	:	MI
Zip	:	48507-2677
Country	:	US
Telephone Number	:	810-732-8336
Fax Number	:	810-963-1674

Provider Business Practice Location Address
First Line	:	4800 S SAGINAW ST
Second Line	:	SUITE 1800
City	:	FLINT
State	:	MI
Zip	:	48507-2677
Country	:	US
Telephone Number	:	810-732-8336
Fax Number	:	810-963-1674

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/06/2025

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