Provider Demographics
NPI:1750356234
Name:PARUNGAO, ALLAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:PARUNGAO
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 1:17645 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2034
Mailing Address - Country:US
Mailing Address - Phone:308-383-0914
Mailing Address - Fax:708-406-0750
Practice Address - Street 1:17645 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2034
Practice Address - Country:US
Practice Address - Phone:308-383-0914
Practice Address - Fax:708-406-0750
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE348822086S0122X
IL36-103048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH33216Medicare UPIN
IL647100Medicare ID - Type Unspecified