Provider Demographics
NPI:1861439028
Name:EGGEN, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:EGGEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:B-515 MAYO MEMORIAL BLDG 294
Mailing Address - Street 2:420 DELAWARE ST. SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-624-9990
Mailing Address - Fax:612-626-2363
Practice Address - Street 1:B-515 MAYO MEMORIAL BLDG 294
Practice Address - Street 2:420 DELAWARE ST. SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-624-9990
Practice Address - Fax:612-626-2363
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-03-28
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Provider Licenses
StateLicense IDTaxonomies
MN36999207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN032025100Medicaid
MN032025100Medicaid
MN050000605Medicare ID - Type Unspecified