Provider Demographics
NPI:1982448296
Name:EVERSHINE MED PLLC
Entity type:Organization
Organization Name:EVERSHINE MED PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:RUKNUDIN
Authorized Official - Last Name:SEWANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:630-853-7049
Mailing Address - Street 1:1701 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7959
Mailing Address - Country:US
Mailing Address - Phone:817-545-7700
Mailing Address - Fax:817-545-2298
Practice Address - Street 1:1701 FOREST RIDGE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7959
Practice Address - Country:US
Practice Address - Phone:817-545-7700
Practice Address - Fax:817-545-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care