Provider Demographics
NPI:1649452699
Name:ALTON WONG MD, SC
Entity type:Organization
Organization Name:ALTON WONG MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-560-1080
Mailing Address - Street 1:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-3426
Mailing Address - Country:US
Mailing Address - Phone:773-585-1955
Mailing Address - Fax:312-674-0248
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:STE 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:773-585-1955
Practice Address - Fax:312-674-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.007690207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601972OtherBS PROV ID
IL31601972OtherBS PROV ID
IL208045Medicare PIN