Provider Demographics
NPI:1225138399
Name:EAGLE MEDICAL PA
Entity Type:Organization
Organization Name:EAGLE MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:9524-747-4167
Mailing Address - Street 1:490 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3002
Mailing Address - Country:US
Mailing Address - Phone:952-474-4167
Mailing Address - Fax:952-474-5700
Practice Address - Street 1:490 OAK ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3002
Practice Address - Country:US
Practice Address - Phone:952-474-4167
Practice Address - Fax:952-474-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNSM 2802Medicare ID - Type Unspecified
MNA94480Medicare UPIN