Provider Demographics
NPI:1558463372
Name:EBERT, ALLAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:M
Last Name:EBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7057 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-8261
Mailing Address - Country:US
Mailing Address - Phone:810-564-3464
Mailing Address - Fax:810-564-3466
Practice Address - Street 1:7057 N CLIO RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-8261
Practice Address - Country:US
Practice Address - Phone:810-564-3464
Practice Address - Fax:810-564-3466
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006057207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3235584Medicaid
MIE31550Medicare UPIN
MIM23560023Medicare PIN