Provider Demographics
NPI:1063973659
Name:THEKKEDATH, EBY ISON (DO)
Entity type:Individual
Prefix:DR
First Name:EBY
Middle Name:ISON
Last Name:THEKKEDATH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:653-1 W 8TH ST # L18
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-383-1003
Mailing Address - Fax:904-244-7388
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-9068
Practice Address - Fax:734-936-5377
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101028492207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine