| Jose S Evangelista Iii Md Pc | |
|
7071 Orchard Lake Rd Suite 333 West Bloomfield MI 48322-3613 | |
| (248) 890-9995 | |
| Not Available |
| Full Name | Jose S Evangelista Iii Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7071 Orchard Lake Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Jose S Evangelista (OWNER) |
| Authorized Official Contact | 2488909995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose S Evangelista Iii Md Pc 7071 Orchard Lake Rd Suite 333 West Bloomfield MI 48322-3613 Ph: (248) 890-9995 | Jose S Evangelista Iii Md Pc 7071 Orchard Lake Rd Suite 333 West Bloomfield MI 48322-3613 Ph: (248) 890-9995 |
| NPI Number | 1871998385 |
|---|---|
| Provider Enumeration Date | 10/27/2014 |
| Last Update Date | 10/27/2014 |
| Medicare PECOS PAC ID | 1850614041 |
|---|---|
| Medicare Enrollment ID | O20141218002414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871998385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 05865R (Michigan) | Primary |
| Provider Name | Douglas C Kinney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487902474 PECOS PAC ID: 6608026315 Enrollment ID: I20121015000426 |
| Provider Name | Jose Salgado Evangelista |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1306029186 PECOS PAC ID: 4385794940 Enrollment ID: I20141021002285 |
| Provider Name | Samantha Joanne Peszko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922690577 PECOS PAC ID: 6103224605 Enrollment ID: I20211014000836 |
| Provider Name | Leila B Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609250133 PECOS PAC ID: 9234596495 Enrollment ID: I20230601002746 |
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