Provider Demographics
NPI:1174502942
Name:EVANS, JOHN N (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 ALLEN RD.
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101
Mailing Address - Country:US
Mailing Address - Phone:313-386-0080
Mailing Address - Fax:313-383-7120
Practice Address - Street 1:8025 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1705
Practice Address - Country:US
Practice Address - Phone:313-386-0080
Practice Address - Fax:313-383-7120
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001476213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2704580Medicaid
MI2704580Medicaid
MI0154500001Medicare NSC