Provider Demographics
NPI:1174634927
Name:ANGSPATT, SOMPONGSE - (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMPONGSE
Middle Name:-
Last Name:ANGSPATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:3515 ITHACA RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1343
Mailing Address - Country:US
Mailing Address - Phone:708-687-7550
Mailing Address - Fax:
Practice Address - Street 1:5601 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2134
Practice Address - Country:US
Practice Address - Phone:708-687-7550
Practice Address - Fax:708-687-7552
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL658810Medicare ID - Type Unspecified
ILC42820Medicare UPIN