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General NPI Number Information
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NPI Number | 1134384365
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Entity Type | Organization
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Legal Business Name | EVERGREEN CONSULTING PHYSICIANS PC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 22780 COTTAGE DR SUITE A
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4313
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Country | US
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Telephone | 248-247-4438
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Fax |
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Provider Business Mailing Address
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Address Line | 22780 COTTAGE DR SUITE A
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4313
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Country | US
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Telephone | 248-247-4438
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINDA JONESSTEPHENS
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Credential | DO
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Telephone | 248-247-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101014089
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License Number State | MI
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