Provider Demographics
NPI:1982836243
Name:EGAN, MICHAEL PATRICK (LAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:EGAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W 43RD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1643
Mailing Address - Country:US
Mailing Address - Phone:612-743-0397
Mailing Address - Fax:
Practice Address - Street 1:2720 W 43RD ST STE 205
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1643
Practice Address - Country:US
Practice Address - Phone:612-743-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist