Most Relevant Information
Provider Data
| NPI Number: | 1003205279 |
| Provider Name: | THERESIA FONGE |
| Entity Type: | Individual |
| Taxonomy Code: | 343900000X |
| Specialty: | Non-emergency Medical Transport (VAN) |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/12/2015 |
| Last Updated: | 01/12/2015 |
Provider Practice Location
4790 HICKORY CREEK DR
APT 8
UNIVERSITY PARK
IL
604842740
Practice Location Phone/Fax
| Phone: | 6309369862 |
| Fax: |
Provider Mailing Location
4790 HICKORY CREEK DR
APT 8
UNIVERSITY PARK
IL
604842740
Provider Mailing Phone/Fax
| Phone: | 6309369862 |
| Fax: |