Individual
DR. KATY K WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1401 EASTLAND DR, BLOOMINGTON, IL 61701-3552
(309) 663-8311
(309) 661-3390
Mailing address
611 W. PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
036110197
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110197
—
IL
01
—
5715384
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/22/2005
Last updated
03/28/2022
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