Healthcare Provider Details

I. General information

NPI: 1376257626
Provider Name (Legal Business Name): EVAN C ESCHKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44200 WOODWARD AVE
PONTIAC MI
48341-5045
US

IV. Provider business mailing address

44200 WOODWARD AVE
PONTIAC MI
48341-5045
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-9490
  • Fax:
Mailing address:
  • Phone: 248-758-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: