Healthcare Provider Details

I. General information

NPI: 1538542238
Provider Name (Legal Business Name): CHOSEN EVOLUTION HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 E AMBER LN
GILBERT AZ
85296-2114
US

IV. Provider business mailing address

2091 E AMBER LN
GILBERT AZ
85296-2114
US

V. Phone/Fax

Practice location:
  • Phone: 480-673-7384
  • Fax:
Mailing address:
  • Phone: 480-673-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number46466
License Number StateAZ

VIII. Authorized Official

Name: DR. SETH KAGAN
Title or Position: OWNER
Credential: M.D.
Phone: 408-673-7384