Healthcare Provider Details

I. General information

NPI: 1073741237
Provider Name (Legal Business Name): BRIAN JOHN EVANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 CALUMET AVE
MUNSTER IN
46321-2811
US

IV. Provider business mailing address

9445 CALUMET AVE
MUNSTER IN
46321-2811
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1060
  • Fax:
Mailing address:
  • Phone: 219-836-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01080413A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01080413A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: