Provider Demographics
NPI:1114009438
Name:FARRES, EVANS JOHN (DO)
Entity Type:Individual
Prefix:MR
First Name:EVANS
Middle Name:JOHN
Last Name:FARRES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2861
Mailing Address - Country:US
Mailing Address - Phone:734-459-5500
Mailing Address - Fax:734-459-4610
Practice Address - Street 1:6050 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2861
Practice Address - Country:US
Practice Address - Phone:734-459-5500
Practice Address - Fax:734-459-4610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEF007326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25803Medicare UPIN
MI5821523Medicare ID - Type Unspecified