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General NPI Number Information
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NPI Number | 1053859108
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Entity Type | Individual
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Provider Name | MICHAEL EVANS JOSEPH DO
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Gender | Male
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 13640 STEELECROFT PKWY STE 310
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City | CHARLOTTE
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State | NC
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Zip | 28278-7936
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Country | US
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Telephone | 704-512-6240
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Fax |
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Provider Business Mailing Address
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Address Line | 5450 FRANTZ RD STE 360
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City | DUBLIN
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State | OH
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Zip | 43016-4141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 91385
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.014117
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-01352
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License Number State | NC
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