Evenson, Mark

Evenson, Mark is an sole proprietor health care provider with primary practice located at 1000 S Main St , Tipton IN 46072-9753. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Evenson, Mark can be contacted via phone (765) 675-8521.

Contact Information

Primary practice address
1000 S Main St Tipton IN 46072-9753
Phone: (765) 675-8521
Fax: (765) 675-8520
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 01032279 Indiana

Profile Details

NPI number 1407845746
LBN Legal business name Evenson, Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 19th, 2005
Last updated Nov 29th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407845746 NPPES
Indiana MEDICAID 100234260A
Indiana Other 000000603583

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