Healthcare Provider Details

I. General information

NPI: 1730686809
Provider Name (Legal Business Name): EVAN STANGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST STE 101
ELYRIA OH
44035-6429
US

IV. Provider business mailing address

731 HUNT CLUB WAY
AVON LAKE OH
44012-4020
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7500
  • Fax:
Mailing address:
  • Phone: 330-592-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34.015545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: