Healthcare Provider Details

I. General information

NPI: 1346478377
Provider Name (Legal Business Name): JOHN FONTAINE EGGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 2014
CHICAGO IL
60602-3941
US

IV. Provider business mailing address

1001 ROHLWING RD
ELK GROVE VILLAGE IL
60007-3217
US

V. Phone/Fax

Practice location:
  • Phone: 601-832-9569
  • Fax: 312-789-4381
Mailing address:
  • Phone: 847-524-8800
  • Fax: 847-524-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036132002
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: