Provider Demographics
NPI:1518954965
Name:LINWONG, METH (MD)
Entity Type:Individual
Prefix:DR
First Name:METH
Middle Name:
Last Name:LINWONG
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-993-6250
Practice Address - Street 1:1200 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4437
Practice Address - Country:US
Practice Address - Phone:618-993-5686
Practice Address - Fax:618-993-5505
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-044940207W00000X
MO2005030239207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0814870013OtherMEDICARE NSC NUMBER
MO0814870015OtherMEDICARE NSC NUMBER
MOP00602754, CI6574OtherMEDICARE RAILROAD
MO0814870006OtherMEDICARE NSC NUMBER
MO136625OtherANTHEM BLUE CROSS BLUE SHIELD OF MO
236679OtherHARMONY HEALTH PLAN
IL036044940Medicaid
042452OtherHEALTH ALLIANCE
IL180020545OtherMEDICARE RAILROAD
MO207689712Medicaid
250010OtherHEALTHLINK
IL0814870001OtherMEDICARE NSC NUMBER
MO0814870017OtherMEDICARE NSC NUMBER
IL0814870009OtherMEDICARE NSC NUMBER
MO0814870002OtherMEDICARE NSC NUMBER
IL0814870024OtherMEDICARE NSC NUMBER
IL036044940Medicaid
IL0814870001OtherMEDICARE NSC NUMBER
IL180020545OtherMEDICARE RAILROAD