Healthcare Provider Details

I. General information

NPI: 1851353825
Provider Name (Legal Business Name): EMIL E EBNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14231 BEADLE LAKE RD
BATTLE CREEK MI
49014-8213
US

IV. Provider business mailing address

14231 BEADLE LAKE RD
BATTLE CREEK MI
49014-8213
US

V. Phone/Fax

Practice location:
  • Phone: 269-962-0441
  • Fax: 269-962-0925
Mailing address:
  • Phone: 269-962-0441
  • Fax: 269-962-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301041180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: