Provider Demographics
NPI:1528564960
Name:EBO, BRIAN N (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:N
Last Name:EBO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:BELOIT HEALTH SYSTEMS INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2298
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-363-5737
Practice Address - Street 1:BELOIT HEALTH SYSTEMS INC
Practice Address - Street 2:1969 W HART ROAD
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2298
Practice Address - Country:US
Practice Address - Phone:608-363-5971
Practice Address - Fax:608-363-5737
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-08-28
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Provider Licenses
StateLicense IDTaxonomies
WI75805-20208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100177332Medicaid