Provider Demographics
NPI:1356369037
Name:CHOW, RAYMOND BONG (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BONG
Last Name:CHOW
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 1:1870 W WINCHESTER RD STE 241
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5360
Mailing Address - Country:US
Mailing Address - Phone:847-549-0170
Mailing Address - Fax:847-549-0172
Practice Address - Street 1:35 TOWER CT
Practice Address - Street 2:SUITE F
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5712
Practice Address - Country:US
Practice Address - Phone:847-360-8440
Practice Address - Fax:847-360-8468
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89728Medicare UPIN