MEDICARE: EGEN ONG M.D.

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	207Q00000X	Family Medicine Physician	036047126	IL

General Provider Information

NPI Number	:	1538334727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EGEN ONG M.D.

Provider Business Mailing Address
First Line	:	6615 N KIMBALL AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3731
Country	:	US
Telephone Number	:	847-983-4178
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-2903
Country	:	US
Telephone Number	:	773-287-0751
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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