Provider Demographics
NPI:1306029186
Name:EVANGELISTA, JOSE SALGADO III (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:SALGADO
Last Name:EVANGELISTA
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:7071 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-626-0470
Mailing Address - Fax:248-626-0221
Practice Address - Street 1:7071 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 333
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3613
Practice Address - Country:US
Practice Address - Phone:248-626-0470
Practice Address - Fax:248-626-0221
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2023-01-09
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Provider Licenses
StateLicense IDTaxonomies
MI4301105958207RC0200X, 2083P0011X, 207RP1001X, 207RP1001X
CT046354208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist