MEDICARE: DR. MICHAEL DANIEL EGAN ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5751-24	WI

General Provider Information

NPI Number	:	1194269092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DANIEL EGAN ATC

Provider Business Mailing Address
First Line	:	2126 N ILLINOIS AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2842
Country	:	US
Telephone Number	:	847-275-4580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 N ILLINOIS AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-2842
Country	:	US
Telephone Number	:	847-275-4580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	05/03/2022

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