Provider Demographics
NPI:1801061254
Name:BINGCANG, ELMAR (PT)
Entity type:Individual
Prefix:
First Name:ELMAR
Middle Name:
Last Name:BINGCANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1974
Mailing Address - Country:US
Mailing Address - Phone:708-349-6544
Mailing Address - Fax:708-349-7994
Practice Address - Street 1:473 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2674
Practice Address - Country:US
Practice Address - Phone:630-295-9900
Practice Address - Fax:630-295-9909
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL621460002 COOKMedicare PIN
IL205070003 DUPAGEMedicare PIN