Individual
JUSTIN MICHAEL EALBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-2060
(414) 259-9290
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301511994
MI
2085R0202X
Diagnostic Radiology Physician
85783
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184253643
—
WI
Enumeration date
04/06/2020
Last updated
05/04/2026
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