Provider Demographics
NPI:1003964156
Name:EVANS, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:112 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4260
Mailing Address - Country:US
Mailing Address - Phone:847-696-3370
Mailing Address - Fax:847-696-9445
Practice Address - Street 1:112 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4260
Practice Address - Country:US
Practice Address - Phone:847-696-3370
Practice Address - Fax:847-696-9445
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36108128207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108128Medicaid
ILI73024Medicare UPIN