Evans, Douglas

Evans, Douglas is an individual health care provider with primary practice located at 2160 S 1St Ave Maguire 1700, Maywood IL 60153-3328. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Evans, Douglas can be contacted via phone (708) 216-3280.

Contact Information

Primary practice address
2160 S 1St Ave Maguire 1700 Maywood IL 60153-3328
Phone: (708) 216-3280
Fax: (708) 216-6223
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 36110469 Illinois

Profile Details

NPI number 1700850005
LBN Legal business name Evans, Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Aug 11th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700850005 NPPES
Illinois MEDICAID 36110469

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