Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036.156949 | IL |
Y | 208600000X | Surgeon | 036.156949 | IL |
NPI | 1013336734 |
---|---|
Provider Name | Cecilia Ong |
First Address | Chicago, IL 60637-1470 |
Second Address | Chicago, IL 60637-1470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 30/07/2021 |