Phoungcherdchoo, Panom

Phoungcherdchoo, Panom is an individual health care provider with primary practice located at 8311 Roosevelt Rd , Forest Park IL 60130-2529. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Phoungcherdchoo, Panom can be contacted via phone (708) 771-7000.

Contact Information

Primary practice address
8311 Roosevelt Rd Forest Park IL 60130-2529
Phone: (708) 771-7000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 036045322 Illinois

Profile Details

NPI number 1366496564
LBN Legal business name Phoungcherdchoo, Panom
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 20th, 2006
Last updated May 22nd, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366496564 NPPES
Illinois MEDICAID 036045322

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