Provider Demographics
NPI:1306890728
Name:SAMETT, EVAN (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SAMETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E BUTTERFIELD RD # 461
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5103
Mailing Address - Country:US
Mailing Address - Phone:973-552-8427
Mailing Address - Fax:312-278-0354
Practice Address - Street 1:8319 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1605
Practice Address - Country:US
Practice Address - Phone:847-323-7166
Practice Address - Fax:312-274-1399
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360740002085R0202X
NY163855-12085R0202X
TXV55982085R0202X, 2085R0204X
IL036-0740002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360740004Medicaid
ILK39125Medicare PIN
ILK02588Medicare ID - Type Unspecified
ILF16042Medicare UPIN
IL0360740004Medicaid