Individual
DR. JOHN WARREN EBERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2650 RIDGE AVE STE 1304, EVANSTON, IL 60201-1718
(847) 570-2477
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036143255
IL
390200000X
Student in an Organized Health Care Education/Training Program
125061655
IL
Other
Enumeration date
07/04/2012
Last updated
07/21/2022
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