MEDICARE: INDOK PARK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036131748	IL
2	208M00000X	Hospitalist Physician	036131748	IL

General Provider Information

NPI Number	:	1063727139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDOK PARK DO

Provider Business Mailing Address
First Line	:	2100 PFINGSTEN RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1301
Country	:	US
Telephone Number	:	847-657-5840
Fax Number	:	847-657-5732

Provider Business Practice Location Address
First Line	:	2100 PFINGSTEN RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026
Country	:	US
Telephone Number	:	847-657-5840
Fax Number	:	847-657-5732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	04/27/2026

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Directions to “ INDOK PARK DO” Practice Location

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