Provider Demographics
NPI:1235361379
Name:WILLIAM SYCHANGCO M.D. S.C.
Entity Type:Organization
Organization Name:WILLIAM SYCHANGCO M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:SYCHANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-772-5334
Mailing Address - Street 1:1802 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5512
Mailing Address - Country:US
Mailing Address - Phone:773-772-5334
Mailing Address - Fax:773-772-2947
Practice Address - Street 1:1802 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5512
Practice Address - Country:US
Practice Address - Phone:773-772-5334
Practice Address - Fax:773-772-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048417261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048417Medicaid
IL036048417Medicaid
IL472670Medicare PIN