Provider Demographics
NPI:1891806907
Name:ONG, ANITA L (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:L
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:PO BOX 88487
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1487
Mailing Address - Country:US
Mailing Address - Phone:312-791-2000
Mailing Address - Fax:312-791-2076
Practice Address - Street 1:2929 S ELLIS AVENUE
Practice Address - Street 2:1 KP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3302
Practice Address - Country:US
Practice Address - Phone:312-791-5344
Practice Address - Fax:312-791-2434
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03093236207ZP0102X
IN01053424A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0360932362Medicaid
IL0360932362Medicaid
IL0360932362Medicaid
IN208480EMedicare ID - Type Unspecified
I18649Medicare UPIN