Provider Demographics
NPI:1992750020
Name:PARK, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-759-1110
Mailing Address - Fax:847-759-8273
Practice Address - Street 1:1550 N NORTHWEST HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1411
Practice Address - Country:US
Practice Address - Phone:847-759-1110
Practice Address - Fax:847-759-8273
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL336056651208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04914Medicare ID - Type Unspecified
ILH35548Medicare UPIN