Provider Demographics
NPI:1063529295
Name:EGLY, ANGELA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:EGLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WILLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7505
Mailing Address - Country:US
Mailing Address - Phone:630-554-0074
Mailing Address - Fax:
Practice Address - Street 1:11 E PLEASANT AVE
Practice Address - Street 2:ROOM 129
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1100
Practice Address - Country:US
Practice Address - Phone:815-786-6988
Practice Address - Fax:815-786-1418
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine