Individual
DR. JOSE L. EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10475 FARMINGTON RD, LIVONIA, MI 48150-5704
(734) 427-9440
(734) 427-1701
Mailing address
36475 5 MILE RD, LIVONIA, MI 48154-1971
(734) 655-1420
(734) 655-1445
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301031560
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Q26368
GROUP
MI
01
—
1108214871
BLUE CROSS
MI
05
—
4199114
—
MI
01
—
510738
CARE CHOICE HMO
MI
Enumeration date
08/30/2006
Last updated
07/08/2007
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