Provider Demographics
NPI:1811082886
Name:CHO, SEONG R (MD)
Entity type:Individual
Prefix:DR
First Name:SEONG
Middle Name:R
Last Name:CHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W MCKINLEY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:92526
Mailing Address - Country:US
Mailing Address - Phone:217-876-6600
Mailing Address - Fax:217-876-6606
Practice Address - Street 1:1001 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4693
Practice Address - Country:US
Practice Address - Phone:217-258-2250
Practice Address - Fax:217-258-2249
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361121602085R0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112160Medicaid
0970490001Medicare NSC
L19616Medicare UPIN
ILK11620Medicare UPIN
K11620Medicare PIN