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Contact Information

JOSE S EVANGELISTA III, MD
7071 ORCHARD LAKE RD
SUITE 333
WEST BLOOMFIELD, MI48322-3613
 Phone: 248-626-0470
 Fax: 248-626-0221
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Critical Care Medicine

207RC0200X 11 Physician/Internal Medicine
 

Undersea and Hyperbaric Medicine

2083P0011X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for JOSE S EVANGELISTA III · (Male)

NPI Number 1306029186
Status Active
Credentials MD
Entity Individual
Enumeration date 12/14/2007
Last updated 01/09/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 4301105958
Hospital affiliation(s)
  • HENRY FORD WEST BLOOMFIELD HOSPITAL - (Acute Care)
    6777 WEST MAPLE ROAD
    W BLOOMFIELD, MI 48322
  • ST MARY MERCY HOSPITAL - (Acute Care)
    36475 FIVE MILE ROAD
    LIVONIA, MI 48154
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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