PONG LAITEERAPONG

CHICAGO, IL
NPI1942545520
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy208D00000X General Practice
(Licence: IL  o36.053201)
Enumeration Date2012-12-07
Last Update Date2012-12-07
Business Address
Dr. PONG LAITEERAPONG M.D.
140 N ASHLAND AVE
CHICAGO, IL 60607
Phone number: 312-850-9411
Mailing Address
Dr. PONG LAITEERAPONG M.D.
140 N ASHLAND AVE
CHICAGO, IL 60607-1802
Phone number: 312-850-9411
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