Provider Demographics
NPI:1053538736
Name:HWANGPO, INKIL (DO)
Entity type:Individual
Prefix:
First Name:INKIL
Middle Name:
Last Name:HWANGPO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744-0614
Mailing Address - Country:US
Mailing Address - Phone:334-624-4442
Mailing Address - Fax:334-624-1405
Practice Address - Street 1:508 GREEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2316
Practice Address - Country:US
Practice Address - Phone:334-624-4442
Practice Address - Fax:334-624-1405
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDO.958OtherLICENSE