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1942545520
PONG LAITEERAPONG
CHICAGO, IL
NPI
1942545520
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
208D00000X General Practice
(Licence: IL o36.053201)
Enumeration Date
2012-12-07
Last Update Date
2012-12-07
Business Address
Dr. PONG LAITEERAPONG M.D.
140 N ASHLAND AVE
CHICAGO, IL 60607
Phone number: 312-850-9411
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Mailing Address
Dr. PONG LAITEERAPONG M.D.
140 N ASHLAND AVE
CHICAGO, IL 60607-1802
Phone number: 312-850-9411
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