Provider Demographics
NPI:1992774301
Name:WONG, SHARON WEI LU (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:WEI LU
Last Name:WONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PETERSON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1085
Mailing Address - Country:US
Mailing Address - Phone:847-327-9127
Mailing Address - Fax:847-996-6766
Practice Address - Street 1:333 PETERSON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1085
Practice Address - Country:US
Practice Address - Phone:847-327-9127
Practice Address - Fax:847-996-6766
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109352Medicaid
IL036109352Medicaid
IL211738Medicare ID - Type Unspecified