Provider Demographics
NPI:1386672525
Name:SILVEIRA, EVANDRO (MD)
Entity Type:Individual
Prefix:
First Name:EVANDRO
Middle Name:
Last Name:SILVEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5793 W MAPLE RD
Mailing Address - Street 2:SUITE 153
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4478
Mailing Address - Country:US
Mailing Address - Phone:248-539-7726
Mailing Address - Fax:248-539-7823
Practice Address - Street 1:5793 W MAPLE RD
Practice Address - Street 2:SUITE 153
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4478
Practice Address - Country:US
Practice Address - Phone:248-539-7726
Practice Address - Fax:248-539-7823
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4254780Medicaid
MI4254780Medicaid