Individual
DR. GREGORY ALAN EKBOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10400 W NORTH AVENUE, #480, MILWAUKEE, WI 53226-2425
(414) 778-6670
(414) 778-6672
Mailing address
P.O. BOX 309, #480, PEWAUKEE, WI 53072-0309
(262) 366-1595
(414) 778-6672
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20232020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020014187
RAILROAD MEDICARE
WI
05
—
21261700
—
WI
Enumeration date
03/20/2007
Last updated
07/06/2011
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