Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 36-136126 | IL |
NPI | 1023274792 |
---|---|
Provider Name | Dr. Raymond M Pongonis JR. |
First Address | Elmhurst, IL 60126-5025 |
Second Address | Naperville, IL 60540-8137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 12/03/2018 |