Provider Demographics
NPI:1669731675
Name:ONG, ROSA T (MD)
Entity type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:T
Last Name:ONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3430 N LAKE SHORE DR APT 7L
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2834
Mailing Address - Country:US
Mailing Address - Phone:773-248-9821
Mailing Address - Fax:773-248-9821
Practice Address - Street 1:3430 N LAKE SHORE DR APT 7L
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2834
Practice Address - Country:US
Practice Address - Phone:773-248-9821
Practice Address - Fax:773-248-9821
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36054291208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice