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Organization
EVERNORTH MEDICAL CARE PROVIDERS NEW YORK PROFESSIONAL CORPORATION
Active
Organization
EVERNORTH MEDICAL CARE PROVIDERS NEW YORK PROFESSIONAL CORPORATION
Active
Other names
Dirk Wales MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE D LAKES (SENIOR PARALEGAL)
(954) 446-0640
Entity
Organization
Contact information
Practice address
555 BROADHOLLOW RD STE 305, MELVILLE, NY 11747-5018
(773) 292-4800
(312) 564-4059
Mailing address
730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN 37067-7331
(773) 292-4800
(312) 564-4059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
NULL
207QA0505X
Adult Medicine Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
NULL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
NULL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/08/2014
Last updated
07/14/2025
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