Individual
WOOSUK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142
(629) 487-0002
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 948-7000
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
49236
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34878800
—
WI
01
—
391264986
TAX ID
WI
Enumeration date
08/11/2006
Last updated
10/15/2023
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