Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | IL |
NPI | 1174634927 |
---|---|
Provider Name | Dr. Sompongse - Angspatt |
First Address | Olympia Fields, IL 60461-1343 |
Second Address | Oak Forest, IL 60452-2134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C42820 | (02) | IL |