Provider Demographics
NPI:1891742995
Name:EKEBERG, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:EKEBERG
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 1:1700 W CENTRAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2474
Mailing Address - Country:US
Mailing Address - Phone:847-259-6200
Mailing Address - Fax:847-259-3540
Practice Address - Street 1:1700 W CENTRAL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2474
Practice Address - Country:US
Practice Address - Phone:847-259-6200
Practice Address - Fax:847-259-3540
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP07903Medicare ID - Type Unspecified
ILC42780Medicare UPIN