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NPI Code Detail

MEDICARE: DR. KATHRYN EGGLESTON M.D.

MEDICARE: DR. KATHRYN EGGLESTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD-47063IA
2207Q00000XFamily Medicine Physician43137MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780689539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN EGGLESTON M.D.
Provider Business Mailing Address
First Line : PO BOX 14826
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-0826
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1965 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1923
Country : US
Telephone Number : 651-696-5520
Fax Number : 612-375-9567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 05/13/2020

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