Healthcare Provider Details

I. General information

NPI: 1962419846
Provider Name (Legal Business Name): WON S LOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9134 COLUMBIA AVE STE A
MUNSTER IN
46321
US

IV. Provider business mailing address

9134 COLUMBIA AVE STE A
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5550
  • Fax: 219-836-2386
Mailing address:
  • Phone: 219-836-5550
  • Fax: 219-836-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01031576
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: