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General NPI Number Information
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NPI Number | 1124052436
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Entity Type | Organization
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Legal Business Name | MANKATO ANESTHESIA ASSOCIATES LTD
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 1400 E MADISON AVE STE 311
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City | MANKATO
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State | MN
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Zip | 56001-5473
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Country | US
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Telephone | 507-387-8980
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Fax | 507-387-8985
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Provider Business Mailing Address
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Address Line | PO BOX 4278
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City | MANKATO
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State | MN
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Zip | 56002-4278
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Country | US
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Telephone | 507-387-8980
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Fax | 507-387-8985
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID J EGLI
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Credential | MD
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Telephone | 507-387-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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