Evergreen Aesthetic Institute LLC

NPI #1710073176 in Effingham, Illinois

Provider Information

NPI Number: 1710073176
Entity Type: Organization
Organization Name: Evergreen Aesthetic Institute LLC
Primary Specialty: Clinic/Center - Ambulatory Fertility Facility
Enumeration Date: Oct 5, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1104 W EVERGREEN AVE
Address 2: SUITE B
City: Effingham
State: Illinois
ZIP Code: 62401-1710
Phone: (217) 342-7090

Authorized Official

Name: DR. THEODORE FIFER, MD
Title: MEDICAL DIRECTOR
Phone: (217) 342-7090

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Ambulatory Fertility Facility — Ambulatory Fertility Facility	261QA0006X	Primary

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