Provider Demographics
NPI:1699828715
Name:ONG, ANITA TANG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:TANG
Last Name:ONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1439
Mailing Address - Country:US
Mailing Address - Phone:630-782-5165
Mailing Address - Fax:
Practice Address - Street 1:405 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1427
Practice Address - Country:US
Practice Address - Phone:708-848-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL655851Medicare ID - Type Unspecified
ILD14433Medicare UPIN