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General NPI Number Information
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NPI Number | 1063973659
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Entity Type | Individual
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Provider Name | EBY ISON THEKKEDATH DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 1500 E MEDICAL CENTER DR
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City | ANN ARBOR
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State | MI
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Zip | 48109-5000
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Country | US
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Telephone | 734-936-9068
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Fax | 734-936-5377
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Provider Business Mailing Address
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Address Line | 653-1 W 8TH ST # L18
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-383-1003
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Fax | 904-244-7388
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 5101028492
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License Number State | MI
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