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NPI Code Detail

MEDICARE: DR. EVAN H BLACK MD

MEDICARE: DR. EVAN H BLACK 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
1207WX0200XOphthalmic Plastic and Reconstructive Surgery Physician4301071533MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932185089
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EVAN H BLACK MD
Provider Business Mailing Address
First Line : 1560 E MAPLE RD
Second Line : SUITE 400-CREDENTIALING
City : TROY
State : MI
Zip : 48083-1138
Country : US
Telephone Number : 313-577-8900
Fax Number : 313-577-0700
Provider Business Practice Location Address
First Line : 4717 ST. ANTOINE
Second Line : KRESGE EYE INSTITUTE
City : DETROIT
State : MI
Zip : 48201-1423
Country : US
Telephone Number : 313-577-8900
Fax Number : 313-577-0700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 06/05/2025

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Directions to “ DR. EVAN H BLACK MD” Practice Location

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