Provider Demographics
NPI:1194269092
Name:EGAN, MICHAEL DANIEL (ATC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:EGAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 N ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2842
Mailing Address - Country:US
Mailing Address - Phone:847-275-4580
Mailing Address - Fax:
Practice Address - Street 1:2126 N ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2842
Practice Address - Country:US
Practice Address - Phone:847-275-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5751-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist