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General NPI Number Information
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NPI Number | 1912989021
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Entity Type | Individual
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Provider Name | LINDA SUE EVANS M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 677 E MAIN ST STE B
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City | CENTREVILLE
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State | MI
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Zip | 49032-8525
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Country | US
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Telephone | 269-467-9011
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Fax | 269-467-9511
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Provider Business Mailing Address
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Address Line | 701 S HEALTH PKWY MEDICAL STAFF OFFICE
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City | THREE RIVERS
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State | MI
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Zip | 49093-8352
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Country | US
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Telephone | 269-273-9789
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Fax | 269-273-9611
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301062677
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License Number State | MI
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