Provider Demographics
NPI:1962419846
Name:LOH, WON S (MD)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:S
Last Name:LOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9134 COLUMBIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-5550
Mailing Address - Fax:219-836-2386
Practice Address - Street 1:9134 COLUMBIA AVE
Practice Address - Street 2:STE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-5550
Practice Address - Fax:219-836-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01031576207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL91107855OtherBCBS IL
IN000000085852OtherBCBS IN
IN1002122301AMedicaid
IL91107855OtherBCBS IL
C25231Medicare UPIN