Provider Demographics
NPI:1558599597
Name:EGLE, ELIZABETH ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSE
Last Name:EGLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1600 S CANTON CENTER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1992
Mailing Address - Country:US
Mailing Address - Phone:734-398-8790
Mailing Address - Fax:734-398-8680
Practice Address - Street 1:1600 S CANTON CENTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1992
Practice Address - Country:US
Practice Address - Phone:734-398-8790
Practice Address - Fax:734-398-8680
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2014-01-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301094055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine