Provider Demographics
NPI:1568426963
Name:LEVI, EVO F (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EVO
Middle Name:F
Last Name:LEVI
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 6016
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-712-8350
Mailing Address - Fax:734-712-8351
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 6016
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-8350
Practice Address - Fax:734-712-8351
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS65380Medicare UPIN