| 3p4care Avondale | |
|
3502 N Kedzie Ave Chicago IL 60618-5622 | |
| (773) 654-1888 | |
| (773) 754-7412 |
| Full Name | 3p4care Avondale |
|---|---|
| Speciality | Family Medicine |
| Location | 3502 N Kedzie Ave, Chicago, Illinois |
| Authorized Official Name and Position | Augustine Wong (DIRECTOR) |
| Authorized Official Contact | 7736541888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 3p4care Avondale 3502 N Kedzie Ave Chicago IL 60618-5622 Ph: (773) 654-1888 | 3p4care Avondale 3502 N Kedzie Ave Chicago IL 60618-5622 Ph: (773) 654-1888 |
| NPI Number | 1467820001 |
|---|---|
| Provider Enumeration Date | 09/14/2015 |
| Last Update Date | 09/14/2015 |
| Medicare PECOS PAC ID | 0648570747 |
|---|---|
| Medicare Enrollment ID | O20151120002335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467820001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036.094438 (Illinois) | Primary |
| Provider Name | Chu Kwan Augustine Wong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205885688 PECOS PAC ID: 8325022452 Enrollment ID: I20040616000736 |
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