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General NPI Number Information
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NPI Number | 1730378423
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Entity Type | Organization
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Legal Business Name | CHUNG M. SONG, MD, SC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 6202 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2029
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Country | US
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Telephone | 773-651-2188
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Fax | 773-651-9655
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Provider Business Mailing Address
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Address Line | 2910 CHEROKEE LN
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City | RIVERWOODS
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State | IL
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Zip | 60015-1609
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Country | US
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Telephone | 847-948-9661
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Fax | 773-651-9655
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHUNG M SONG
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Credential | M.D.
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Telephone | 847-948-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 042.617778
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License Number State | IL
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