Individual
VAN DO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 296-7929
Mailing address
355 E. ERIE ST, CHICAGO, IL 60611-2654
(312) 238-1000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-109509
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036109509
—
IL
01
—
P00145545
RAILROAD MEDICARE
IL
Enumeration date
07/28/2006
Last updated
04/22/2022
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