Provider Demographics
NPI:1023274792
Name:PONGONIS, RAYMOND M JR (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:PONGONIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 W BUTTERFIELD RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5025
Mailing Address - Country:US
Mailing Address - Phone:630-574-0460
Mailing Address - Fax:630-574-0470
Practice Address - Street 1:1220 HOBSON RD STE 114
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-961-2960
Practice Address - Fax:630-961-3296
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2018-03-12
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Provider Licenses
StateLicense IDTaxonomies
IL36-136126207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400179600Medicare PIN