| Pong Medical Center Llc | |
|
5151 N Lincoln Ave Chicago IL 60625-2520 | |
| (773) 784-0900 | |
| (773) 784-6173 |
| Full Name | Pong Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5151 N Lincoln Ave, Chicago, Illinois |
| Authorized Official Name and Position | Suchat Ponglorpisita (MD) |
| Authorized Official Contact | 7732189625 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pong Medical Center Llc 11110 Martindale Dr Westchester IL 60154-4920 Ph: (773) 218-9625 | Pong Medical Center Llc 5151 N Lincoln Ave Chicago IL 60625-2520 Ph: (773) 784-0900 |
| NPI Number | 1871853259 |
|---|---|
| Provider Enumeration Date | 05/20/2012 |
| Last Update Date | 05/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871853259 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036048043 (Illinois) | Primary |
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