Provider Demographics
NPI:1689665549
Name:EGAN, JOHN P JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:EGAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:STE 324B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-726-5075
Practice Address - Fax:231-722-1827
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-02-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301048705207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1763OtherMEDICARE GROUP PTAN
MI2803005Medicaid
MIB46756Medicare UPIN
MIB46756Medicare UPIN