Organization
EVOLVING MEDICAL INTEGRATION SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANELLE BEVILACQUA (MANAGING MEMBER)
(214) 475-1523
Entity
Organization
Contact information
Practice address
5389 MONTEREY DR, FRISCO, TX 75034-4079
(214) 475-1523
Mailing address
5389 MONTEREY DR, FRISCO, TX 75034-4079
(214) 475-1523
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
207L00000X
Anesthesiology Physician
—
—
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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