Healthcare Provider Details

I. General information

NPI: 1124581749
Provider Name (Legal Business Name): GARSENG WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N MICHIGAN AVE STE 2550
CHICAGO IL
60611-3182
US

IV. Provider business mailing address

625 N MICHIGAN AVE STE 2550
CHICAGO IL
60611-3182
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-7740
  • Fax: 312-640-7736
Mailing address:
  • Phone: 312-640-7740
  • Fax: 312-640-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.159757
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: