Healthcare Provider Details

I. General information

NPI: 1245972645
Provider Name (Legal Business Name): LISA MARIE EGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W OGDEN AVE
WESTMONT IL
60559-1419
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-968-7025
  • Fax: 630-328-2375
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-180407
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: