Individual
EVARISTUS UDOISA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
326 W 64TH ST, CHICAGO, IL 60621-3114
(773) 651-6977
(773) 651-3978
Mailing address
326 W 64TH ST, CHICAGO, IL 60621-3114
(773) 651-6977
(773) 651-3978
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360658588
—
IL
Enumeration date
06/09/2006
Last updated
07/08/2007
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