Provider Demographics
NPI:1609127059
Name:EVANS, MICHEL ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:ANTHONY
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:159 EXECUTIVE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-0830
Mailing Address - Fax:434-792-0468
Practice Address - Street 1:159 EXECUTIVE DR STE C
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-0830
Practice Address - Fax:434-792-0468
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020019207YS0123X
VA0102204818207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery