Dr. Michael John Ebertz
Dermatologist MOHS-Micrographic Surgeon
14000 Nicollet Ave Suite 304
Burnsville
, Minnesota 55337-5790
Dr. Michael John Ebertz
Dermatologist MOHS-Micrographic Surgeon
14000 Nicollet Ave Suite 304
Burnsville
, Minnesota 55337-5790
(952) 898-1600
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Michael John Ebertz
- 14000 Nicollet Ave Ste 304
- Burnsville, MN
- Zip : 55337-5784
- Phone : (952) 898-1600
Second Address
- Dr. Michael John Ebertz
- 14000 Nicollet Ave Suite 304
- Burnsville, MN
- Zip : 55337-5790
- Phone : (952) 898-1600
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 36998 | MN |
| N | 207ND0101X | MOHS-Micrographic Surgeon | 36998 | MN |
National Provider Identifier
| NPI | 1144386392 |
|---|---|
| Provider Name | Dr. Michael John Ebertz |
| First Address | Burnsville, MN 55337-5784 |
| Second Address | Burnsville, MN 55337-5790 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/12/2006 |
| Last Update Date | 15/10/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 225522700 | (05) | MN |
| G17770 | (02) | MN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.