Provider Demographics
NPI:1558484519
Name:EGGLESTON, BEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:EDWARD
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:
Practice Address - Street 1:704 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2949
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-06-24
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Provider Licenses
StateLicense IDTaxonomies
MI43010804902085R0202X
MDD00656712085R0202X
UT295098-12052085R0202X
IDM-104092085R0202X
OH35.0966652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology