Provider Demographics
NPI:1972550002
Name:EGELSTON, SETH M (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:M
Last Name:EGELSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:327 CAPITAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3924
Mailing Address - Country:US
Mailing Address - Phone:269-969-6040
Mailing Address - Fax:269-969-6047
Practice Address - Street 1:327 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3924
Practice Address - Country:US
Practice Address - Phone:269-969-6040
Practice Address - Fax:269-969-6047
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4271066Medicaid
MI0N10050003Medicare PIN
MIG81117Medicare UPIN