Provider Demographics
NPI:1003870734
Name:SCHLAM, EVAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:H
Last Name:SCHLAM
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 1:1475 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-7688
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:BOX 016960
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-7688
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86272207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2696347-00Medicaid
FL2696347-00Medicaid
FLI07039Medicare UPIN