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General NPI Number Information
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NPI Number | 1679557789
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Entity Type | Individual
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Provider Name | ROBERT J EGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 19305 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-2718
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Country | US
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Telephone | 313-549-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 NICOLET PL
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City | DETROIT
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State | MI
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Zip | 48207-2838
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Country | US
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Telephone | 313-549-3149
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301-074125
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License Number State | MI
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