Provider Demographics
NPI:1548237720
Name:EVANS, CARLY MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7301 OHMS LANE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:4050 COON RAPIDS BLVD
Practice Address - Street 2:MERCY MEDICAL CENTER
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-236-7144
Practice Address - Fax:763-236-7733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN46350207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46350OtherMN MEDICAL LICENSE
MN46350OtherMN MEDICAL LICENSE