Evergreen Health Cre

NPI #1164457701 in Oak Lawn, Illinois

Provider Information

NPI Number: 1164457701
Entity Type: Organization
Organization Name: Evergreen Health Cre
Primary Specialty: Specialist
Enumeration Date: Jul 12, 2006
Last Updated: Jul 17, 2007

Practice Location

Address: 5540 W 111TH ST
City: Oak Lawn
State: Illinois
ZIP Code: 60453-5035
Phone: (708) 423-8440

Authorized Official

Name: DR. DAVID J SMITH, M.D.
Title: OWNER
Phone: (708) 423-8440

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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