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General NPI Number Information
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NPI Number | 1538542238
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Entity Type | Organization
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Legal Business Name | CHOSEN EVOLUTION HEALTHCARE LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 2091 E AMBER LN
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City | GILBERT
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State | AZ
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Zip | 85296-2114
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Country | US
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Telephone | 480-673-7384
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Fax |
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Provider Business Mailing Address
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Address Line | 2091 E AMBER LN
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City | GILBERT
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State | AZ
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Zip | 85296-2114
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Country | US
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Telephone | 480-673-7384
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SETH KAGAN
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Credential | M.D.
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Telephone | 408-673-7384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 46466
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License Number State | AZ
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