| Evergreen Bridgeport LLC | |
|
3548 S Normal Ave Chicago IL 60609 | |
| (312) 731-6185 | |
| Not Available |
| Full Name | Evergreen Bridgeport LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3548 S Normal Ave, Chicago, Illinois |
| Authorized Official Name and Position | Xiuzhen Li (PRESIDENT) |
| Authorized Official Contact | 3127316185 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Bridgeport LLC 3548 S Normal Ave Chicago IL 60609 Ph: (312) 731-6185 | Evergreen Bridgeport LLC 3548 S Normal Ave Chicago IL 60609 Ph: (312) 731-6185 |
| NPI Number | 1770407397 |
|---|---|
| Provider Enumeration Date | 08/06/2026 |
| Last Update Date | 08/06/2026 |
| Certification Date | 07/27/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770407397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
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