Healthcare Provider Details

I. General information

NPI: 1336226406
Provider Name (Legal Business Name): JOHN N. EVANS, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 ALLEN RD
ALLEN PARK MI
48101-1705
US

IV. Provider business mailing address

8025 ALLEN RD
ALLEN PARK MI
48101-1705
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-0080
  • Fax: 313-383-7120
Mailing address:
  • Phone: 313-386-0080
  • Fax: 313-383-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001476
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN NORMAN EVANS
Title or Position: PRESIDENT
Credential: DPM
Phone: 313-386-0080