Provider Demographics
NPI:1518492719
Name:EGAN, MICHAEL (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:EGAN
Suffix:
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARION AVE
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4003
Mailing Address - Country:US
Mailing Address - Phone:215-380-9332
Mailing Address - Fax:
Practice Address - Street 1:300 ALPHA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2908
Practice Address - Country:US
Practice Address - Phone:412-599-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPD000006224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist