MEDICARE: PATIENT-PRACTITIONER PARTNERSHIP LLC

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	261QP2300X	Primary Care Clinic/Center		IL

General Provider Information

NPI Number	:	1366620981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT-PRACTITIONER PARTNERSHIP LLC

Provider Business Mailing Address
First Line	:	2043 W 35TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1103
Country	:	US
Telephone Number	:	773-254-0229
Fax Number	:	773-254-0229

Provider Business Practice Location Address
First Line	:	2043 W 35TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1103
Country	:	US
Telephone Number	:	773-254-0229
Fax Number	:	773-254-0229

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CHU-KWAN AUGUSTINE WONG
Credential	:	MD
Telephone Number	:	773-254-0229

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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