Provider Demographics
NPI:1316986706
Name:HUGH MEDICAL ASSOC
Entity type:Organization
Organization Name:HUGH MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG-HUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-0200
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:#304
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-425-0200
Mailing Address - Fax:708-425-0208
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:#304
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-425-0200
Practice Address - Fax:708-425-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618686OtherBCBS IL
ILL32361Medicare PIN
ILL13927Medicare PIN
ILD13284Medicare UPIN