Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101006057 | MI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 5101006057 | MI |
NPI | 1558463372 |
---|---|
Provider Name | Dr. Allan M Ebert |
First Address | Mount Morris, MI 48458-8261 |
Second Address | Mount Morris, MI 48458-8261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 12/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3235584 | (05) | MI |
E31550 | (02) | MI |