Basic Information
| Provider Information | |||||||||
| NPI: | 1457537011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERHART | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2734 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606523937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739184700 | ||||||||
| FaxNumber: | 7733133763 | ||||||||
| Practice Location | |||||||||
| Address1: | 2734 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606523937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739184700 | ||||||||
| FaxNumber: | 7733133763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101017552 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 5101017552 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 036134050 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.