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NPI Code Detail

MEDICARE: JUSTIN MICHAEL EALBA MD

MEDICARE: JUSTIN MICHAEL EALBA MD
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
12085R0202XDiagnostic Radiology Physician85783WI
22085R0202XDiagnostic Radiology Physician4301511994MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184253643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN MICHAEL EALBA MD
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number : 313-874-4806
Fax Number : 313-876-1305
Provider Business Practice Location Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-805-2060
Fax Number : 414-259-9290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2020
Last Update Date : 05/04/2026

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