Individual
PETER WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 GOOD SAMARITAN WAY STE 235, MOUNT VERNON, IL 62864-2476
(618) 899-3980
Mailing address
PO BOX 955860 MC 845, SAINT LOUIS, MO 63195-2560
(636) 498-5944
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036097977
IL
2086S0129X
Vascular Surgery Physician
4301076962
MI
Other
Enumeration date
06/13/2006
Last updated
10/21/2020
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