Provider Demographics
NPI:1942231667
Name:PARUNGAO, RENE SHERWIN (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:SHERWIN
Last Name:PARUNGAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:SHERWIN
Other - Last Name:PARUNGAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B202
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8417
Mailing Address - Country:US
Mailing Address - Phone:815-455-2752
Mailing Address - Fax:815-455-2789
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B202
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-455-2752
Practice Address - Fax:815-455-2789
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030325208600000X
IL036115790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115790OtherSTATE LICENSE
MO1942231667Medicaid
ILK29524OtherMEDICARE ID#
MO718000036OtherMEDICARE MO
MO718000036OtherMEDICARE MO