Healthcare Provider Details

I. General information

NPI: 1700992625
Provider Name (Legal Business Name): TERRY WAYNE EBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 RIDGE RD SUITE 1
MUNSTER IN
46321-1643
US

IV. Provider business mailing address

509 RIDGE RD SUITE 1
MUNSTER IN
46321-1643
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1050
  • Fax: 219-836-4969
Mailing address:
  • Phone: 219-836-1050
  • Fax: 219-836-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01022150A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: