Organization
A. PETER EVANGELISTA, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUSTUS PETER EVANGELISTA M (CEO)
(248) 626-0470
Entity
Organization
Contact information
Practice address
10475 FARMINGTON RD, LIVONIA, MI 48150-5704
(734) 427-9440
(734) 427-1071
Mailing address
7071 ORCHARD LAKE RD, SUITE 333, WEST BLOOMFIELD, MI 48322-3613
(248) 626-0470
(248) 626-0221
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301108922
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301108922
LICENSE
MI
Enumeration date
09/01/2016
Last updated
09/01/2016
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