Individual
EVAN D STATHULIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
725 BUCKLES COURT NORTH, SUITE 100, GAHANNA, OH 43230
(614) 471-9654
(614) 392-4586
Mailing address
725 BUCKLES COURT NORTH, SUITE 100, GAHANNA, OH 43230
(614) 471-9654
(614) 392-4586
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-065900
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122012
—
OH
Enumeration date
03/01/2006
Last updated
11/21/2018
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