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General NPI Number Information
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NPI Number | 1669325239
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Entity Type | Individual
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Provider Name | MR. PHILLIP S EVALEN
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Gender | Male
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1600 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2510
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Country | US
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Telephone | 954-355-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1972 SUMMERTON PL
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City | NORTHBROOK
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State | IL
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Zip | 60062-6049
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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