Provider Demographics
NPI:1053433375
Name:EGELAND, BRENT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MICHAEL
Last Name:EGELAND
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 1:1400 N IH 35 STE 320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8320
Mailing Address - Fax:
Practice Address - Street 1:1400 N IH 35 STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-8320
Practice Address - Fax:512-324-8326
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105445207XS0106X, 207X00000X
MI4301081432390200000X
MN54404207XS0106X
TXP33152082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
WIENROLLEDMedicaid
MNENROLLEDMedicaid
MNP01021688OtherRAIL ROAD - MEDICARE
MN200003116Medicare PIN