Healthcare Provider Details

I. General information

NPI: 1245419209
Provider Name (Legal Business Name): PAUL EBBEN H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 MAIN ST
MARINETTE WI
54143-1808
US

IV. Provider business mailing address

140 CORPORATE DR SUITE 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax: 920-887-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1213-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: