MEDICARE: EVON GERGIS

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	1041C0700X	Clinical Social Worker	6851116853	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

General Provider Information

NPI Number	:	1417424110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVON GERGIS

Provider Business Mailing Address
First Line	:	5168 BLAIR DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-4049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 W BIG BEAVER RD STE 315
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-5242
Country	:	US
Telephone Number	:	248-354-8460
Fax Number	:	248-354-4979

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	09/07/2023

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Directions to “ EVON GERGIS ” Practice Location

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