Provider Demographics
NPI:1891974192
Name:WON S LOH. MD. PC.
Entity Type:Organization
Organization Name:WON S LOH. MD. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WON
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-5550
Mailing Address - Street 1:9134 COLUMBIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2907
Mailing Address - Country:US
Mailing Address - Phone:219-836-5550
Mailing Address - Fax:219-836-2386
Practice Address - Street 1:9134 COLUMBIA AVE STE A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:219-836-5550
Practice Address - Fax:219-836-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031576207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN703450Medicare PIN