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NPI Code Detail

MEDICARE: ROBERT EVANS

MEDICARE:   ROBERT  EVANS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1710534276
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT EVANS
Provider Business Mailing Address
First Line : 205 WADSWORTH RD
Second Line :
City : WADSWORTH
State : OH
Zip : 44281-9580
Country : US
Telephone Number : 234-217-8882
Fax Number : 234-217-8941
Provider Business Practice Location Address
First Line : 205 WADSWORTH RD
Second Line :
City : WADSWORTH
State : OH
Zip : 44281-9580
Country : US
Telephone Number : 234-217-8882
Fax Number : 234-217-8941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 08/20/2019

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Directions to “ ROBERT EVANS ” Practice Location

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