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Individual

DR. EVAN H BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4717 ST. ANTOINE, KRESGE EYE INSTITUTE, DETROIT, MI 48201-1423
(313) 577-8900
(313) 577-0700
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(313) 577-8900
(313) 577-0700

Taxonomy

Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
4301071533
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3462161
MI
Enumeration date
12/21/2005
Last updated
06/05/2025
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