Provider Demographics
NPI:1700910502
Name:EVINGER, KURT (SA-C)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:
Last Name:EVINGER
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14963 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60151-5200
Mailing Address - Country:US
Mailing Address - Phone:815-766-0168
Mailing Address - Fax:
Practice Address - Street 1:14963 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:MAPLE PARK
Practice Address - State:IL
Practice Address - Zip Code:60151-5200
Practice Address - Country:US
Practice Address - Phone:815-766-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2017-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000543246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant