MEDICARE: DR. DAVID J EVERINGHAM D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DE008308	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5820200	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1215939244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J EVERINGHAM D.O.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	201 3RD ST STE 200
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2605
Country	:	US
Telephone Number	:	734-697-9065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/19/2023

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