Provider Demographics
NPI:1316094899
Name:EBEJER, MARCUS ALEXANDER (ATC)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:ALEXANDER
Last Name:EBEJER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24810 VERDANT DR
Mailing Address - Street 2:#204
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2131
Mailing Address - Country:US
Mailing Address - Phone:313-690-1324
Mailing Address - Fax:
Practice Address - Street 1:216 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer