DR. MICHAEL JOHN EBERTZ (NPI# 1144386392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144386392 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL JOHN EBERTZ |
| Credential | M.D. |
| Practice Address |
14000 Nicollet Ave Suite 304 Burnsville MN 55337-5790 |
| Mailing Address |
14000 Nicollet Ave Ste 304 Burnsville MN 55337-5784 |
| Practice Telephone | 9528981600 |
| Mailing Telephone | 9528981600 |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 36998 | MN | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
36998 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 225522700 | 05 |
| Street Address |
14000 NICOLLET AVE SUITE 304 |
| City | BURNSVILLE |
| State | MN |
| Zip Code | 55337-5790 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407848658 | Steven L Johnson | Family Medicine | 14000 Nicollet Ave, Ste 100, Burnsville, MN 55337-5790 | 2005-08-15 |
| 1356955819 | Erin K. Allen, D.d.s., Pllc | Clinic/Center | 14000 Nicollet Ave, Ste 302, Burnsville, MN 55337-5784 | 2020-09-02 |
| 1386089993 | Neil Gordon Johnson | Family Medicine | 14000 Nicollet Ave, Suite 100, Burnsville, MN 55337-5790 | 2013-05-09 |
| 1477886687 | Jared Lee Schroeder | Physical Therapist | 14000 Nicollet Ave, Suite 200, Burnsville, MN 55337-5790 | 2009-09-08 |
| 1689857955 | Kim D Fjelstad Dpm Pa | Podiatrist | 14000 Nicollet Ave, 306, Burnsville, MN 55337-5790 | 2007-12-10 |
| 1437345055 | Tracy M Luchsinger | Physician Assistant | 14000 Nicollet Ave, Suite 100, Burnsville, MN 55337-5790 | 2007-09-18 |
| 1063613131 | Tiffany T Waki | Dentist | 14000 Nicollet Ave, Suite 300, Burnsville, MN 55337-5790 | 2007-05-29 |
| 1619025798 | Kuipers Orthodontics | Dentist | 14000 Nicollet Ave, Suite 300, Burnsville, MN 55337-5790 | 2007-01-08 |
| 1790841989 | Heidi Leigh Foster | Dermatology | 14000 Nicollet Ave, Suite 304, Burnsville, MN 55337-5790 | 2006-12-29 |
| 1508965195 | Nancy Holm | Dentist | 14000 Nicollet Ave, Suite 302, Burnsville, MN 55337-5790 | 2006-09-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053939397 | Alpha Quality Care1 L. L. C. | Home Infusion | 12924 18th Ave South, Burnsville, MN 55337 | 2020-07-13 |
| 1568085900 | Kathryn Harris | Counselor | 11939 W. River Hills Dr., Burnsville, MN 55337 | 2020-05-20 |
| 1952941254 | Noah Home Care Inc. | Home Health | 13521 Nicollet Lane, Burnsville, MN 55337 | 2020-01-14 |
| 1750854287 | Baraka Home Care LLC | Nursing Care | 1700 James Place, Burnsville, MN 55337 | 2019-01-08 |
| 1699298778 | Raphael Cheron-dittmann | Hearing Instrument Specialist | 14000 Nicollet Ave. S., Suite 303, Burnsville, MN 55337 | 2017-07-20 |
| 1669909818 | Mercy Home Care Ltd | Hospice Care, Community Based | 1020 E 146th St Ste 220d, Burnsville, MN 55337 | 2017-05-18 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1730542572 | Iris Reproductive Psychiatric Clinic | Clinical Nurse Specialist | 1500 Mcandrews Road W, Ste 227, Burnsville, MN 55337 | 2016-03-30 |
| 1740657204 | Mercy Link, LLC | Home Health | 13005 Salem Pl, Burnsville, MN 55337 | 2015-08-31 |
| 1669852158 | Mixa Dipak Patel | Physical Therapy Assistant | 8380 Hiawatha Ave, Eden Prairie, MN 55337 | 2015-06-01 |
| Find all providers in zip 55337 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962871608 | Lakes Dermatology, Pa | Dermatology | 14305 Southcross Dr W, Suite 110, Burnsville, MN 55306-7009 | 2015-09-23 |
| 1427243898 | Rehana Leila Ahmed-saucedo | Dermatology | 14305 Southcross Dr, Suite 110, Burnsville, MN 55306 | 2007-09-10 |
| 1144586165 | Joseph Anton Scherman | Dermatology | 14000 Fairview Dr, Burnsville, MN 55337-5713 | 2012-04-03 |
| 1790841989 | Heidi Leigh Foster | Dermatology | 14000 Nicollet Ave, Suite 304, Burnsville, MN 55337-5790 | 2006-12-29 |
| 1619954963 | Michelle M Blaeser | Dermatology | 14000 Fairview Dr, Burnsville, MN 55337-5713 | 2005-12-28 |
| 1336125517 | Victoria Vanroy | Dermatology | 14000 Fairview Dr, Burnsville, MN 55337-5713 | 2005-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194133157 | Adam Schmitt | Dermatology | 2 Carlson Pkwy N Ste 240, Plymouth, MN 55447 | 2014-07-22 |
| 1578982773 | Lori Ann Fiessinger | Dermatology | 420 Delaware Street Se, Mmc 98, Minneapolis, MN 55455 | 2014-04-15 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1033537782 | Erin Sellinger | Dermatology | 2 Carlson Pkwy N, Ste 240, Plymouth, MN 55447-4485 | 2014-03-31 |
| 1033555230 | Samuel Blake Ecker | Dermatology | 3655 Plymouth Blvd Ste 110, Minneapolis, MN 55446-3665 | 2013-05-14 |
| 1295078913 | Jessica Jane Newman | Dermatology | 4-240, Phillips-wangensteen Bldg., 516 Delaware Street S.e., Mail Code 98, Minneapolis, MN 55455 | 2013-04-01 |
| 1437416088 | Tiffany Lynn Shih | Dermatology | 401 Phalen Blvd # Ms 41102b, Saint Paul, MN 55130-5302 | 2012-04-20 |
| 1124317383 | Sara Anne Hylwa | Dermatology | 730 South 8th Street, Department of Dermatology, Minneapolis, MN 55415 | 2011-03-28 |
| 1770885360 | Thomas Joseph Kalb | Dermatology | 13420 106th St., Young America, MN 55397-5401 | 2010-12-02 |
| 1346550092 | John D Sarbacker | Dermatology | 1216 23rd Ave S, Moorhead, MN 56560-4536 | 2010-10-15 |
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| City | BURNSVILLE |
| Zip Code | 55337 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.