Provider Demographics
NPI:1912990466
Name:WINSTON, EVONNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVONNE
Middle Name:MARIE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2315 N LAKE DR
Mailing Address - Street 2:SUITE 701
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4518
Mailing Address - Country:US
Mailing Address - Phone:414-271-4211
Mailing Address - Fax:414-271-1821
Practice Address - Street 1:2315 N LAKE DR
Practice Address - Street 2:SUITE 701
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4518
Practice Address - Country:US
Practice Address - Phone:414-271-4211
Practice Address - Fax:414-271-1821
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI24340207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB57665Medicare UPIN