Individual
DR. KENDALL L WONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 FORT JESSE RD, SUITE 280, NORMAL, IL 61761-6286
(309) 452-1788
(309) 862-1302
Mailing address
2200 FORT JESSE RD, SUITE 280, NORMAL, IL 61761-6286
(309) 452-1788
(309) 862-1302
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36106966
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106966*1
—
IL
Enumeration date
06/06/2006
Last updated
07/08/2007
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