MEDICARE: DR. KAREN S EVANS MD

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	01035240A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000111034	OTHER	IN	ANTHEM GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7539045	OTHER	IN	AETNA PIN

General Provider Information

NPI Number	:	1497746861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN S EVANS MD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5720
Country	:	US
Telephone Number	:	260-469-6605
Fax Number	:	260-969-3066

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	10/14/2022

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