MEDICARE: STEPHEN B EVANS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	350076073	OH
2	2086S0105X	Surgery of the Hand (Surgery) Physician	350076073	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235128547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN B EVANS JR. MD

Provider Business Mailing Address
First Line	:	26908 DETROIT RD STE 200
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2399
Country	:	US
Telephone Number	:	440-871-6560
Fax Number	:

Provider Business Practice Location Address
First Line	:	26908 DETROIT RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2398
Country	:	US
Telephone Number	:	440-871-6060
Fax Number	:	440-871-6726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	04/09/2021

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