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NPI Code Detail

MEDICARE: MR. PHILLIP S EVALEN

MEDICARE: MR. PHILLIP S EVALEN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1669325239
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILLIP S EVALEN
Provider Business Mailing Address
First Line : 1972 SUMMERTON PL
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-6049
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 S ANDREWS AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33316-2510
Country : US
Telephone Number : 954-355-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ MR. PHILLIP S EVALEN ” Practice Location

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