Provider Demographics
NPI:1801228036
Name:EVANS, MEGAN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3547
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-8804
Practice Address - Street 1:5145 N. CALIFORNIA AVE.
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-989-3800
Practice Address - Fax:773-907-1005
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085005702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant