Provider Demographics
NPI:1760417679
Name:YOUSHOCK, EVA L (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:L
Last Name:YOUSHOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:708-634-4602
Mailing Address - Fax:630-495-1770
Practice Address - Street 1:6700 N ROCHESTER RD
Practice Address - Street 2:STE 212
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306
Practice Address - Country:US
Practice Address - Phone:248-650-1510
Practice Address - Fax:248-650-1526
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301049372207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631754Medicare PIN
E77738Medicare UPIN