MEDICARE: DR. SOMPONGSE - ANGSPATT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0201X	Pediatric Allergy/Immunology Physician		IL

General Provider Information

NPI Number	:	1174634927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOMPONGSE - ANGSPATT M.D.

Provider Business Mailing Address
First Line	:	3515 ITHACA RD
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1343
Country	:	US
Telephone Number	:	708-687-7550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 VICTORIA DR
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2134
Country	:	US
Telephone Number	:	708-687-7550
Fax Number	:	708-687-7552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/06/2021

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