Provider Demographics
NPI:1699718106
Name:EGLI, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:EGLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 LEHMAN AVE.
Mailing Address - Street 2:PO BOX 698
Mailing Address - City:TOPEKA
Mailing Address - State:IN
Mailing Address - Zip Code:46571-0698
Mailing Address - Country:US
Mailing Address - Phone:260-593-2902
Mailing Address - Fax:260-593-3492
Practice Address - Street 1:315 LEHMAN AVE.
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571-0698
Practice Address - Country:US
Practice Address - Phone:260-593-2902
Practice Address - Fax:260-593-3492
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029154207Q00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100159710Medicaid
IN100159710Medicaid
INB28939Medicare UPIN