Individual ProviderEvan Richard MiddaughSocial WorkerBehavioral Health & Social Service ProvidersPractice Address2711 N Mildred Ave Apt 2b, Chicago, IL 60614-2771(239) 851-5661PECOS EnrollmentBased on the most recent information from CMS, provider Evan Richard Middaugh does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1316588718Provider TypeIndividualFull NameMiddaugh, Evan RichardGenderMaleSole ProprietorYesEnumeration Date10/7/2019Last Updated10/7/2019Contact InformationPractice LocationPractice Address2711 N Mildred Ave Apt 2b, Chicago, IL 60614-2771Phone(239) 851-5661FaxUnlisted FaxMailing LocationMailing Address2711 N Mildred Ave Apt 2b, Chicago, IL 60614-2771Phone(239) 851-5661FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149.021545Illinois