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General NPI Number Information
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NPI Number | 1225191844
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Entity Type | Individual
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Provider Name | JOHN C. EGGENBERGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5325 ELLIOTT DR STE 104
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City | YPSILANTI
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State | MI
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Zip | 48197-8633
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Country | US
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Telephone | 734-712-8150
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Fax | 734-712-8151
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Provider Business Mailing Address
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Address Line | 5325 ELLIOTT SUITE 104, ASSOCIATES IN GENERAL AND VASCULAR SURGERY
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City | YPSILANTI
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State | MI
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Zip | 49197
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Country | US
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Telephone | 734-712-8150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 4301405869
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License Number State | MI
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