Individual
DR. MICHAEL JOHN EBERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14000 NICOLLET AVE, SUITE 304, BURNSVILLE, MN 55337-5790
(952) 898-1600
Mailing address
14000 NICOLLET AVE STE 304, BURNSVILLE, MN 55337-5784
(952) 898-1600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
36998
MN
207ND0101X
MOHS-Micrographic Surgery Physician
36998
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225522700
—
MN
Enumeration date
12/29/2006
Last updated
10/15/2020
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