Provider Demographics
NPI:1760401582
Name:EVANS, MANDY LEE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 N MARSHFIELD AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1016
Mailing Address - Country:US
Mailing Address - Phone:773-880-3256
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ # 10
Practice Address - Street 2:DEPARTMENT OF CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361154462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry