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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366496564 | NPPES |
| Illinois | MEDICAID | 036045322 |
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