Healthcare Provider Details

I. General information

NPI: 1093632788
Provider Name (Legal Business Name): EVAN CHRISTOPHER KVINTUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26210 HARPER AVE
SAINT CLAIR SHORES MI
48081-2203
US

IV. Provider business mailing address

26210 HARPER AVE
SAINT CLAIR SHORES MI
48081-2203
US

V. Phone/Fax

Practice location:
  • Phone: 888-485-8636
  • Fax: 586-218-3367
Mailing address:
  • Phone: 888-485-8636
  • Fax: 586-218-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: