Healthcare Provider Details

I. General information

NPI: 1124058045
Provider Name (Legal Business Name): CHRISTOPHER M EVANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N MERIDIAN ST SUITE 275
CARMEL IN
46032-1405
US

IV. Provider business mailing address

13430 N MERIDIAN ST SUITE 275
CARMEL IN
46032-1405
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8810
  • Fax: 317-582-8863
Mailing address:
  • Phone: 317-582-8810
  • Fax: 317-582-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01055850A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: