Ebirim, Reginald A

Ebirim, Reginald A is an individual health care provider with primary practice located at 1405 Mill St , New London WI 54961-2155. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ebirim, Reginald A can be contacted via phone (920) 531-2000.

Contact Information

Primary practice address
1405 Mill St New London WI 54961-2155
Phone: (920) 531-2000
Fax: (920) 531-2098
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036113328 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 68084 Wisconsin

Profile Details

NPI number 1396702957
LBN Legal business name Ebirim, Reginald A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396702957 NPPES
Illinois MEDICAID 036113328
Illinois MEDICAID 036113328-6

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