Organization
EVERGREEN SHERIDAN LABORATORIES LTD
Active
Organization
EVERGREEN SHERIDAN LABORATORIES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN A JUTZI LAB TECHNOLOGIST (OWNER)
(708) 423-2660
Entity
Organization
Contact information
Practice address
9760 S KEDZIE AVE, EVERGREEN PARK, IL 60805
(708) 423-2660
(708) 423-1960
Mailing address
9760 S KEDZIE AVE, EVERGREEN PARK, IL 60805
(708) 423-2660
(708) 423-1960
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50000044
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/08/2006
Last updated
06/12/2008
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