Individual
JACK THOMAS EGNATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
281 W 11TH ST, BLOOMINGTON, IN 47404-3718
(219) 798-5636
Mailing address
281 W 11TH ST, BLOOMINGTON, IN 47404-3718
(219) 798-5636
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/02/2025
Last updated
01/02/2025
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