Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 3158199 | OH |
NPI | 1669097184 |
---|---|
Provider Name | Michael Dee Anthony Evans |
First Address | Vandalia, OH 45377-3051 |
Second Address | Liberty Township, OH 45044-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 10/06/2020 |