Organization
ADELBERT EVANGELISTA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADELBERT D EVANGELISTA M.D. (PRESIDENT)
(734) 427-8081
Entity
Organization
Contact information
Practice address
10475 FARMINGTON RD, LIVONIA, MI 48150-5704
(734) 427-8081
(734) 427-1701
Mailing address
10475 FARMINGTON RD, LIVONIA, MI 48150-5704
(734) 427-8081
(734) 427-1701
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301081292
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0808208032
BCBSM
MI
Enumeration date
09/13/2007
Last updated
09/13/2007
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