Individual
DR. JOHN DOUGLAS EBERSOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-6064
Mailing address
26901 BEAUMONT BLVD, STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1865
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301074124
MI
2085R0204X
Vascular & Interventional Radiology Physician
Primary
4301074124
MI
Other
Enumeration date
11/30/2006
Last updated
10/22/2020
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