MEDICARE: DELLA ELLIS EVANS M. D.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	01078907A	IN

General Provider Information

NPI Number	:	1588644744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELLA ELLIS EVANS M. D.

Provider Business Mailing Address
First Line	:	PO BOX 3407
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47733-3407
Country	:	US
Telephone Number	:	812-450-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 OAK HILL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47711-4364
Country	:	US
Telephone Number	:	812-485-2580
Fax Number	:

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

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	12/15/2022

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