Provider Demographics
NPI:1194140129
Name:EVOLVE MEDICAL SPA PLLC
Entity type:Organization
Organization Name:EVOLVE MEDICAL SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NITZAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-934-0948
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0571
Mailing Address - Country:US
Mailing Address - Phone:919-934-0948
Mailing Address - Fax:919-934-0193
Practice Address - Street 1:101 E MARKET ST STE 3C
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3981
Practice Address - Country:US
Practice Address - Phone:919-205-1376
Practice Address - Fax:919-205-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31119261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty