Provider Demographics
NPI:1245223874
Name:EGGERT, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:EGGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-788-6968
Mailing Address - Fax:517-796-9122
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-788-6968
Practice Address - Fax:517-796-9122
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043561208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
100913OtherGREAT LAKES HEALTH PLAN
105036OtherCARE CHOICES/PREFERRED
4599487OtherAETNA (HEALTH PLANS)
MI0203806701OtherBCBS OF MI
MI1720063OtherPHP (HEALTH PLAN)
P58588OtherBCN (HEALTH PLAN)
MI2114910Medicaid
MI1720063OtherPHP (HEALTH PLAN)
P58588OtherBCN (HEALTH PLAN)