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General NPI Number Information
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NPI Number | 1790205706
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Entity Type | Individual
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Provider Name | KATHERINE BLAIRE EGAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 545 BARNHILL DRIVE, EMERSON HALL 232 IU SCHOOL OF MEDICINE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202
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Country | US
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Telephone | 317-278-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 4506 N PENNSYLVANIA ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-1730
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Country | US
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Telephone |
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 01091179A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11019435A
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License Number State | IN
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