Individual
MICHAEL RICHARD EVANKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
311 W 24TH ST, SUITE 101, ERIE, PA 16502-2665
(814) 452-4214
(814) 459-7823
Mailing address
311 W 24TH ST STE 101, ERIE, PA 16502-2668
(814) 452-4214
(814) 459-7823
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD060400L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025198402
UNIVERA
NY
05
—
0017973700003
—
PA
01
—
02079629
NY MEDICAL ASSISTANCE
NY
01
—
1041777
GATEWAY
PA
01
—
1278964
AETNA
PA
01
—
182151
UNISON
PA
01
—
212543
UPMC
PA
01
—
261978
BLUE SHIELD
PA
01
—
2662659
OH MEDICAL ASSISTANCE
OH
01
—
P00324768
RR MEDICARE
PA
Enumeration date
05/31/2006
Last updated
10/01/2020
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