Provider Demographics
NPI:1154326007
Name:TONG, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E BURLINGTON ST
Mailing Address - Street 2:STE C
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2382
Mailing Address - Country:US
Mailing Address - Phone:708-442-0333
Mailing Address - Fax:708-442-9863
Practice Address - Street 1:105 E BURLINGTON ST
Practice Address - Street 2:STE C
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2382
Practice Address - Country:US
Practice Address - Phone:708-442-0333
Practice Address - Fax:708-442-9863
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36084251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084251Medicaid
IL036084251Medicaid
ILF36688Medicare UPIN