MEDICARE: EVOLUTION HEALTH GROUP LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1780399915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTION HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	350 LINCOLN RD FL 2
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3183
Country	:	US
Telephone Number	:	305-317-1081
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 LINCOLN RD FL 2
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3183
Country	:	US
Telephone Number	:	305-317-1081
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHERIDAN PRICE
Credential	:
Telephone Number	:	240-475-7200

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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