MEDICARE: CHESTER A EVANS D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO1231	FL

General Provider Information

NPI Number	:	1356348080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESTER A EVANS D.P.M.

Provider Business Mailing Address
First Line	:	11300 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-6628
Country	:	US
Telephone Number	:	305-899-3250
Fax Number	:	305-899-3253

Provider Business Practice Location Address
First Line	:	893 NE 125TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5711
Country	:	US
Telephone Number	:	305-893-9366
Fax Number	:	305-893-4408

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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