Provider Demographics
NPI:1144372061
Name:EVENHUIS CARDIOLOGY & INTERNAL MEDICINE
Entity type:Organization
Organization Name:EVENHUIS CARDIOLOGY & INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVENHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:239-262-5770
Mailing Address - Street 1:PO BOX 12018
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-2018
Mailing Address - Country:US
Mailing Address - Phone:239-262-5770
Mailing Address - Fax:
Practice Address - Street 1:1351 PINE ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4260
Practice Address - Country:US
Practice Address - Phone:239-262-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80066207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3868Medicare PIN