Healthcare Provider Details

I. General information

NPI: 1790730612
Provider Name (Legal Business Name): EVANSVILLE MULTI-SPECIALTY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 E COLUMBIA ST
EVANSVILLE IN
47715-9133
US

IV. Provider business mailing address

PO BOX 5646
EVANSVILLE IN
47716-5646
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-1948
  • Fax: 812-401-5777
Mailing address:
  • Phone: 812-475-1948
  • Fax: 812-401-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOTFI HADAD
Title or Position: OWNER
Credential: MEDICAL DOCTOR
Phone: 812-475-1948