MEDICARE: EBM INTERNAL MEDICINE INC

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
1	207R00000X	Internal Medicine Physician	ME95409	FL

General Provider Information

NPI Number	:	1477684108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBM INTERNAL MEDICINE INC

Provider Business Mailing Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-674-2699
Fax Number	:	904-674-6710

Provider Business Practice Location Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-674-2699
Fax Number	:	904-674-6710

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ERNST BERTHONY MICHEL
Credential	:	M.D.
Telephone Number	:	904-674-2699

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/08/2011

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Directions to “EBM INTERNAL MEDICINE INC ” Practice Location

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