Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036133302 | IL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 036133302 | IL |
NPI | 1326363896 |
---|---|
Provider Name | Evan Sterling Plowgian |
First Address | Gurnee, IL 60031-1512 |
Second Address | Gurnee, IL 60031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2010 |
Last Update Date | 02/04/2021 |