Provider Demographics
NPI:1982727756
Name:EBERHARDT, JAMES PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILIP
Last Name:EBERHARDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25755 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1013
Mailing Address - Country:US
Mailing Address - Phone:734-782-7003
Mailing Address - Fax:734-782-7005
Practice Address - Street 1:25755 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-1013
Practice Address - Country:US
Practice Address - Phone:734-782-7003
Practice Address - Fax:734-782-7005
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016494207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538198700OtherGROUP NPI
MI73092Medicaid
MI0P33780Medicare UPIN