Provider Demographics
NPI:1336126317
Name:EKBERG, FREDRICK E (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:E
Last Name:EKBERG
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 1:925 E SUPERIOR ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2238
Mailing Address - Country:US
Mailing Address - Phone:218-722-3700
Mailing Address - Fax:218-722-8705
Practice Address - Street 1:925 E SUPERIOR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2238
Practice Address - Country:US
Practice Address - Phone:218-722-3700
Practice Address - Fax:218-722-8705
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN169402085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN375397200Medicaid
WI30725300Medicaid
1601359OtherMEDICA
HP32349OtherHEALTHPARTNERS
MN470000069Medicare PIN
MN300004405Medicare PIN
1601359OtherMEDICA
MN309000813Medicare ID - Type Unspecified
MN375397200Medicaid
MN470001318Medicare PIN
MND79971Medicare UPIN