Organization
MANU TONGWARIN MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANU TONGWARIN MD (PRESIDENT)
(618) 542-8221
Entity
Organization
Contact information
Practice address
316 E FRANKLIN ST, DU QUOIN, IL 62832-2302
(618) 542-8221
(618) 542-8221
Mailing address
316 E FRANKLIN ST, DU QUOIN, IL 62832-2302
(618) 542-3822
(618) 542-8221
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007300031
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/22/2006
Last updated
08/22/2020
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