Organization
EVERGREEN UPTOWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
XIUZHEN LI (PRESIDENT)
(312) 731-6185
Entity
Organization
Contact information
Practice address
1147 W. BALMORAL AVE, CHICAGO, IL 60640
(773) 754-0027
Mailing address
1147 W. BALMORAL AVE, CHICAGO, IL 60640
(773) 754-0027
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/23/2025
Last updated
04/23/2025
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