Healthcare Provider Details

I. General information

NPI: 1174579627
Provider Name (Legal Business Name): SYNERGY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S KEDZIE AVE SUITE A
MERRIONETTE PARK IL
60803-6302
US

IV. Provider business mailing address

11600 S KEDZIE AVE SUITE A
MERRIONETTE PARK IL
60803-6302
US

V. Phone/Fax

Practice location:
  • Phone: 708-389-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY VUONG
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 708-389-2300