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General NPI Number Information
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NPI Number | 1407974835
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Entity Type | Individual
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Provider Name | LERWUT WONGSARNPIGOON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3444 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2201
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Country | US
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Telephone | 847-559-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 1256 ASBURY AVE
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City | WINNETKA
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State | IL
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Zip | 60093-1404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | IL
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