Provider Demographics
NPI:1427214139
Name:EVANS, VALARY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:VALARY
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4089
Mailing Address - Country:US
Mailing Address - Phone:313-982-4358
Mailing Address - Fax:313-982-4370
Practice Address - Street 1:4900 MERCURY DRIVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-4358
Practice Address - Fax:313-982-4370
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301086834OtherSTATE LICENSE