Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A172637 | CA |
NPI | 1699129858 |
---|---|
Provider Name | Michael Eggerstedt |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 27/07/2021 |