Healthcare Provider Details

I. General information

NPI: 1710092655
Provider Name (Legal Business Name): KEVIN D EGLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E PLEASANT AVE ROOM 129
SANDWICH IL
60548-1100
US

IV. Provider business mailing address

203 WILLOWWOOD DR
OSWEGO IL
60543-7505
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-6988
  • Fax: 815-786-1418
Mailing address:
  • Phone: 630-554-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036101052
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036101052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: