Provider Demographics
NPI:1720604333
Name:EVOVLEDMD LLC
Entity Type:Organization
Organization Name:EVOVLEDMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-955-3196
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-1450
Mailing Address - Country:US
Mailing Address - Phone:623-404-1821
Mailing Address - Fax:
Practice Address - Street 1:4253 N CRAFTSMAN CT
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-8525
Practice Address - Country:US
Practice Address - Phone:623-404-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health