Individual
DR. VAN EVANOFF JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2204 N SECTION ST, SUITE B, SULLIVAN, IN 47882-0010
(812) 268-2556
(812) 268-2652
Mailing address
2204 N SECTION ST PO BOX 10, SUITE B, SULLIVAN, IN 47882-0010
(812) 268-2556
(812) 268-2652
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
01053652A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000338733
BLUE CROSS & BLUE SHIELD
IN
05
—
200262220
—
IN
01
—
P01625340
RAILROAD MEDICARE
IN
Enumeration date
05/31/2005
Last updated
05/25/2016
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