Provider Demographics
NPI:1194575423
Name:EGANA, MICAH
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:EGANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 PLANK DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-7078
Mailing Address - Country:US
Mailing Address - Phone:502-994-5186
Mailing Address - Fax:
Practice Address - Street 1:901 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2188
Practice Address - Country:US
Practice Address - Phone:502-994-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program