1972540458 NPI number — JOSHUA B EVANS MD

Table of content: JOSHUA B EVANS MD (NPI 1972540458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972540458 NPI number — JOSHUA B EVANS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
JOSHUA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972540458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 SAINT ANTOINE ST
Provider Second Line Business Mailing Address:
UNIVERSITY PEDIATRICIANS UHC 5D MAILBOX 226
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-4405
Provider Business Mailing Address Fax Number:
313-966-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 BEAUBIEN -
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF MI 1ST FL
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-832-8290
Provider Business Practice Location Address Fax Number:
313-993-0081
Provider Enumeration Date:
06/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301080224 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)