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General NPI Number Information
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NPI Number | 1730686809
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Entity Type | Individual
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Provider Name | EVAN STANGER DO
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Gender | Male
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 125 E BROAD ST STE 101
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City | ELYRIA
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State | OH
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Zip | 44035-6429
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Country | US
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Telephone | 440-329-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 731 HUNT CLUB WAY
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City | AVON LAKE
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State | OH
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Zip | 44012-4020
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Country | US
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Telephone | 330-592-5521
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 34.015545
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License Number State | OH
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