Individual
EVANGELINE DE SAGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
(319) 768-1000
Mailing address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036097387
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009847
HEALTH ALLIANCE
—
05
—
036097387
—
IL
01
—
1922250
BCBS IL
IL
01
—
32913278
CHAMPUS
—
01
—
P00047449
RAILROAD MEDICARE
—
Enumeration date
09/14/2006
Last updated
02/09/2016
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