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General NPI Number Information
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NPI Number | 1922405521
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Entity Type | Individual
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Provider Name | JEFFREY LEIGHTON TONG MD
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Gender | Male
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE UNIVERSITY OF CHICAGO MEDICAL CENTER
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR SUITE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-7594
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 113.000075
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License Number State | IL
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