Provider Demographics
NPI:1477504710
Name:EVANS, GRETCHEN M (DPM)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1483
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61555-1483
Mailing Address - Country:US
Mailing Address - Phone:309-347-3886
Mailing Address - Fax:309-347-4002
Practice Address - Street 1:3305 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6237
Practice Address - Country:US
Practice Address - Phone:309-347-3668
Practice Address - Fax:309-347-3890
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005001213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04565Medicare PIN
ILU09250Medicare UPIN