Basic Information
| Provider Information | |||||||||
| NPI: | 1942231667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARUNGAO | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | SHERWIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PARUNGAO | ||||||||
| OtherFirstName: | R | ||||||||
| OtherMiddleName: | SHERWIN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B202 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154552752 | ||||||||
| FaxNumber: | 8154552789 | ||||||||
| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B202 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154552752 | ||||||||
| FaxNumber: | 8154552789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2013030325 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036115790 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036115790 | 01 | IL | STATE LICENSE | OTHER | 1942231667 | 05 | MO | MEDICAID | K29524 | 01 | IL | MEDICARE ID# | OTHER | 718000036 | 01 | MO | MEDICARE MO | OTHER |