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NPI Code Detail

MEDICARE: ALTON WONG MD

MEDICARE: ALTON WONG MD
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
1207RH0003XHematology & Oncology Physician036059957IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982681458
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTON WONG MD
Provider Business Mailing Address
First Line : 62647 COLLECTION CENTER DR
Second Line :
City : CHICAGO
State : IL
Zip : 60693-0626
Country : US
Telephone Number : 812-962-6407
Fax Number : 812-471-9282
Provider Business Practice Location Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4417
Country : US
Telephone Number : 773-585-1955
Fax Number : 773-284-5268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 07/15/2016

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