Provider Demographics
NPI:1366439226
Name:EGAN, BRIAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:EGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-7608
Mailing Address - Country:US
Mailing Address - Phone:815-725-0350
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST STE 120
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6652
Practice Address - Country:US
Practice Address - Phone:815-725-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087726Medicaid
G30922Medicare UPIN