Provider Demographics
NPI:1447297932
Name:EBRIGHT, JOHN R (M D)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:EBRIGHT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 S RENAUD RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:726 S RENAUD RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1799
Practice Address - Country:US
Practice Address - Phone:313-882-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037528207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
JE037528OtherCOMMERCIAL-COMMERCIAL NUMBER
440Q263940OtherBLUE CROSS-BLUE CROSS
MI447487310Medicaid
JE037528OtherCHAMPUS-CHAMPUS
JE037528OtherCOMMERCIAL-COMMERCIAL NUMBER
JE037528OtherCOMMERCIAL-COMMERCIAL NUMBER