Provider Demographics
NPI:1376501700
Name:EVANS, TAMEA DESHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMEA
Middle Name:DESHAWN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-361-1222
Mailing Address - Fax:502-368-1258
Practice Address - Street 1:1900 BLUEGRASS AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1183
Practice Address - Country:US
Practice Address - Phone:502-361-1222
Practice Address - Fax:502-368-1258
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01492223 (KOHMG)OtherRR MEDICARE
KY64123037Medicaid
KYK047993Medicare PIN
KY64123037Medicaid
I62243Medicare UPIN