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NPI Code Detail

MEDICARE: DR. NELSON KIRK WONG MD

MEDICARE: DR. NELSON KIRK WONG MD
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
1207Q00000XFamily Medicine Physician036106344IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578563854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NELSON KIRK WONG MD
Provider Business Mailing Address
First Line : PO BOX 3008
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-3008
Country : US
Telephone Number : 618-457-0450
Fax Number : 618-457-7329
Provider Business Practice Location Address
First Line : 13245 KESSLER RD
Second Line :
City : CAIRO
State : IL
Zip : 62914-3101
Country : US
Telephone Number : 618-734-4400
Fax Number : 618-734-2884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 10/27/2020

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Directions to “ DR. NELSON KIRK WONG MD” Practice Location

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