Individual
DAVID J EBERDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
160 VALLEY DR, LODI, WI 53555-1464
(608) 592-3296
Mailing address
160 VALLEY DR, LODI, WI 53555-1464
(608) 592-3296
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
424
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42911700
—
WI
Enumeration date
02/22/2006
Last updated
03/24/2021
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