Individual
REGINALD A EBIRIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2000
(920) 531-2098
Mailing address
2670 LAKE REUNION RD, DECATUR, IL 62521-8407
(217) 543-3869
(217) 543-3651
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036113328
IL
207Q00000X
Family Medicine Physician
Primary
68084
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113328
—
IL
05
—
036113328-6
—
IL
Enumeration date
04/27/2006
Last updated
03/17/2018
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