Provider Demographics
NPI:1073770459
Name:ISABELO M EVANGELISTA
Entity Type:Organization
Organization Name:ISABELO M EVANGELISTA
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELO
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-828-3847
Mailing Address - Street 1:540 ASTER LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4413
Mailing Address - Country:US
Mailing Address - Phone:847-828-3847
Mailing Address - Fax:
Practice Address - Street 1:540 ASTER LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4413
Practice Address - Country:US
Practice Address - Phone:847-828-3847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable