Provider Demographics
NPI:1346553815
Name:HALCHISHICK, EVAN R (DO)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:R
Last Name:HALCHISHICK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:30701 BARRINGTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5106
Mailing Address - Country:US
Mailing Address - Phone:248-616-1170
Mailing Address - Fax:248-589-9875
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 437
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-616-1170
Practice Address - Fax:248-589-9875
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2015-01-07
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Provider Licenses
StateLicense IDTaxonomies
MI5101018701208100000X, 204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine