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General NPI Number Information
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NPI Number | 1982681458
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Entity Type | Individual
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Provider Name | ALTON WONG MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 5525 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4417
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Country | US
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Telephone | 773-585-1955
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Fax | 773-284-5268
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Provider Business Mailing Address
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Address Line | 62647 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0626
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Country | US
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Telephone | 812-962-6407
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Fax | 812-471-9282
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036059957
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License Number State | IL
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