Basic Information
| Provider Information | |||||||||
| NPI: | 1225138399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAGLE MEDICAL PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 OAK ST | ||||||||
| Address2: | |||||||||
| City: | EXCELSIOR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553313002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524744167 | ||||||||
| FaxNumber: | 9524745700 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 OAK ST | ||||||||
| Address2: | |||||||||
| City: | EXCELSIOR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553313002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524744167 | ||||||||
| FaxNumber: | 9524745700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEIFERT | ||||||||
| AuthorizedOfficialFirstName: | MILTON | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 95247474167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14736 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.