Provider Demographics
NPI:1851353825
Name:EBNER, EMIL E (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:E
Last Name:EBNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14231 BEADLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8213
Mailing Address - Country:US
Mailing Address - Phone:269-962-0441
Mailing Address - Fax:269-962-0925
Practice Address - Street 1:14231 BEADLE LAKE RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8213
Practice Address - Country:US
Practice Address - Phone:269-962-0441
Practice Address - Fax:269-962-0925
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4706486Medicaid
MI4939942Medicaid
MI4939942Medicaid