Organization
S PONGCHED MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPACHAI SUWATANAPONGCHED M.D. (PRESIDENT)
(708) 596-2445
Entity
Organization
Contact information
Practice address
11416 S MICHIGAN AVE, CHICAGO, IL 60628-4932
(773) 660-8515
(630) 455-9633
Mailing address
211 ELGIN AVE, 6M, FOREST PARK, IL 60130-1382
(708) 596-2445
(630) 455-9633
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP5130543
D.E.A.
IL
Enumeration date
03/04/2007
Last updated
08/22/2020
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