Individual
DR. MARISTELLA S EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2378
Mailing address
1293 SOUTHFIELD RD, BIRMINGHAM, MI 48009-3081
(734) 945-7295
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
35127325
OH
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
4301116571
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
A112635
CA
Other
Enumeration date
05/17/2010
Last updated
06/30/2025
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