Provider Demographics
NPI:1972526879
Name:EVANS, BRUCE W (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:EVANS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 PARK FOREST DR
Mailing Address - Street 2:STE 210
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7306
Mailing Address - Country:US
Mailing Address - Phone:248-265-4611
Mailing Address - Fax:248-265-4645
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:STE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-265-4611
Practice Address - Fax:248-265-4645
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-02-04
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Provider Licenses
StateLicense IDTaxonomies
MI4301041955207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1763068-10Medicaid
MI1763068-10Medicaid
MIOF36192008Medicare ID - Type Unspecified