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General NPI Number Information
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NPI Number | 1235361379
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Entity Type | Organization
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Legal Business Name | WILLIAM SYCHANGCO M.D. S.C.
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 1802 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5512
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Country | US
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Telephone | 773-772-5334
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Fax | 773-772-2947
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Provider Business Mailing Address
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Address Line | 1802 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5512
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Country | US
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Telephone | 773-772-5334
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Fax | 773-772-2947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM W. SYCHANGCO
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Credential | M.D.
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Telephone | 773-772-5334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036048417
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License Number State | IL
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