Basic Information
| Provider Information | |||||||||
| NPI: | 1336126317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EKBERG | ||||||||
| FirstName: | FREDRICK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 E SUPERIOR ST | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558022238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187223700 | ||||||||
| FaxNumber: | 2187228705 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 E SUPERIOR ST | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558022238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187223700 | ||||||||
| FaxNumber: | 2187228705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 16940 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | 16940 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 375397200 | 05 | MN | MEDICAID | 30725300 | 05 | WI | MEDICAID | 1601359 | 01 | MEDICA | OTHER | HP32349 | 01 | HEALTHPARTNERS | OTHER |