Organization
NGU MD. WELLNESS LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE N. NGU M.D. (MEDICAL DIRECTOR)
(708) 250-8424
Entity
Organization
Contact information
Practice address
400 E RANDOLPH ST, APT 2711, CHICAGO, IL 60601-7329
(708) 250-8424
Mailing address
400 E RANDOLPH ST, APT 2711, CHICAGO, IL 60601-7329
(708) 250-8424
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
036092049
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K14846
MEDICARE ID TYPE UNSPECIFIED
IL
Enumeration date
10/15/2011
Last updated
10/20/2011
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