MEDICARE: MARK EBERHAGE, PHD LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1992650378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK EBERHAGE, PHD LLC

Provider Business Mailing Address
First Line	:	1532 E BELLEVIEW PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3956
Country	:	US
Telephone Number	:	414-293-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 E BELLEVIEW PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3956
Country	:	US
Telephone Number	:	414-293-2733
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK G EBERHAGE
Credential	:	PHD
Telephone Number	:	414-293-2733

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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