Individual
MICHAEL MCEVOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 829-4246
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 829-4246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01816
KS
363A00000X
Physician Assistant
Primary
2018034963
MO
363AM0700X
Medical Physician Assistant
15-01816
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002353
MEDICARE PTAN
KS
05
—
201126740A
—
KS
Enumeration date
09/09/2015
Last updated
10/09/2018
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