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General NPI Number Information
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NPI Number | 1457693764
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Entity Type | Individual
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Provider Name | MICHAEL ALLAN EVANS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 225 E. CHICAGO AVENUE, 19 DEPARTMENT OF ANESTHESIOLOGY
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-5187
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Fax | 312-227-9730
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Provider Business Mailing Address
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Address Line | 225 E. CHICAGO AVENUE, BOX 19 DEPARTMENT OF ANESTHESIOLOGY
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-5187
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Fax | 312-227-9730
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 73233
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 036.145481
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License Number State | IL
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