Provider Demographics
NPI:1801973912
Name:EVKOSKA, VESNA (DO)
Entity type:Individual
Prefix:DR
First Name:VESNA
Middle Name:
Last Name:EVKOSKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 24 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3201
Mailing Address - Country:US
Mailing Address - Phone:586-677-3310
Mailing Address - Fax:586-677-3326
Practice Address - Street 1:42500 HAYES RD SUITE 800
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6761
Practice Address - Country:US
Practice Address - Phone:586-228-0200
Practice Address - Fax:586-228-3634
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG54997Medicare UPIN
MI0M40550Medicare PIN