Individual
EVAN R WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1199 HADLEY RD, MOORESVILLE, IN 46158-1788
(317) 831-2273
(317) 831-9347
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002428A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300012898
—
IN
Enumeration date
02/13/2018
Last updated
09/28/2023
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