Provider Demographics
NPI:1912951849
Name:MANU TONGWARIN MD LTD
Entity Type:Organization
Organization Name:MANU TONGWARIN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANU
Authorized Official - Middle Name:
Authorized Official - Last Name:TONGWARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-542-8221
Mailing Address - Street 1:316 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-2302
Mailing Address - Country:US
Mailing Address - Phone:618-542-3822
Mailing Address - Fax:618-542-8221
Practice Address - Street 1:316 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-2302
Practice Address - Country:US
Practice Address - Phone:618-542-8221
Practice Address - Fax:618-542-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007300031OtherBLUE CROSS BLUE SHIELD
ILC38962Medicare UPIN
IL299060Medicare ID - Type Unspecified