Provider Demographics
NPI:1467454876
Name:EBELING, BRIAN T (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:EBELING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7801 EAST BUSH LAKE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3114
Mailing Address - Country:US
Mailing Address - Phone:952-985-8911
Mailing Address - Fax:952-985-8999
Practice Address - Street 1:9358 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1455
Practice Address - Country:US
Practice Address - Phone:952-985-8500
Practice Address - Fax:952-985-8599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN20228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A96520Medicare UPIN