JOSE S EVANGELISTA III MD PC
Osteopathic Medicine at Orchard Lake Rd, West Bloomfield, MI

License number
Michigan 05865R
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: JOSE S EVANGELISTA III MD
Title: OWNER
Phone: (248) 890-9995
Address
Address
7071 Orchard Lake Rd SUITE 333, West Bloomfield, MI 48322
National Provider ID: 1871998385
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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JOSE S. EVANGELISTA, III, M.D., PC

West Bloomfield, MI

Registration:
Oct 24, 2014
Addresses:
7071 Orch Lk Rd STE 333, West Bloomfield, MI 48322 (Physical)
Michigan (Mailing)
State ID:
05865R
Business type:
Domestic Profit Corporation
Agent:
Marcus Evangelista

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