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NPI Code Detail

MEDICARE: TRIPHENA MICHELLE WONG D.O.

MEDICARE:   TRIPHENA MICHELLE WONG  D.O.
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
12084P0800XPsychiatry Physician036149513IL

General Provider Information

NPI Number : 1447647094
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRIPHENA MICHELLE WONG D.O.
Provider Business Mailing Address
First Line : 2649 N RICHMOND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60647-1709
Country : US
Telephone Number : 312-640-7740
Fax Number : 312-640-7736
Provider Business Practice Location Address
First Line : 625 N MICHIGAN AVE STE 2550
Second Line :
City : CHICAGO
State : IL
Zip : 60611-3182
Country : US
Telephone Number : 312-640-7740
Fax Number : 312-640-7736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2015
Last Update Date : 10/02/2025

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Directions to “ TRIPHENA MICHELLE WONG D.O.” Practice Location

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