Provider Demographics
NPI:1679290324
Name:EVOLVE FOOT AND WOUNDCARE
Entity Type:Organization
Organization Name:EVOLVE FOOT AND WOUNDCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-602-9947
Mailing Address - Street 1:27 HOSPITAL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5954
Mailing Address - Country:US
Mailing Address - Phone:619-602-9947
Mailing Address - Fax:
Practice Address - Street 1:27 HOSPITAL AVE STE 301
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5954
Practice Address - Country:US
Practice Address - Phone:619-602-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty