Provider Demographics
NPI:1033180005
Name:EBELING, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:EBELING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-5307
Mailing Address - Fax:785-270-7646
Practice Address - Street 1:634 SW MULVANE
Practice Address - Street 2:STE 202
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2716
Practice Address - Country:US
Practice Address - Phone:785-232-3555
Practice Address - Fax:785-232-3980
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423970207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27583Medicare UPIN
F27583Medicare UPIN
KS100132590AMedicaid