Organization
TERRY EBERT, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY W EBERT M.D. (PRESIDENT)
(219) 836-1050
Entity
Organization
Contact information
Practice address
509 RIDGE RD, SUITE 1, MUNSTER, IN 46321-1643
(219) 836-1050
(219) 836-4969
Mailing address
509 RIDGE RD, SUITE 1, MUNSTER, IN 46321-1643
(219) 836-1050
(219) 836-4969
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
01022150A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01022150A
PHYSICIAN LICENSE NUMBER
—
01
—
50001124A
CORPORATION REGISTRATION
IN
Enumeration date
04/17/2007
Last updated
03/07/2023
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