MEDICARE: MICHAEL D. EVANS M.D.

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	207Q00000X	Family Medicine Physician	MD00013530	WA

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	:	1992849848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D. EVANS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 34581
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1581
Country	:	US
Telephone Number	:	509-241-7349
Fax Number	:	509-241-7628

Provider Business Practice Location Address
First Line	:	5615 W SUNSET HWY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-9454
Country	:	US
Telephone Number	:	206-901-6117
Fax Number	:	206-901-6108

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	09/01/2009

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