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Dr. Chang Ki Song, MD
Vascular Surgery Physician in Peoria, Illinois
NPI 1609892728

Chang Ki Song is a Vascular Surgery Physician based in Peoria, IL and is specialized in Vascular Surgery. Chang Ki Song practices in Peoria, IL and has the professional credentials of MD. The NPI Number for Chang Ki Song is 1609892728 and holds a License No. 036060265 (Illinois).

The current practice location address for Chang Ki Song is 5401 N Knoxville Ave, Peoria, IL and can be reached out via phone at 309-691-1092 and via fax at 309-689-6092. You can also correspond with Chang Ki Song through the mailing address at 5401 N KNOXVILLE AVE, PEORIA, IL - 61614-5098 (mailing address contact number: 309-691-1092).

Location: 5401 N Knoxville Ave, Peoria, IL, 61614-5098
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609892728
Provider Name
Chang Ki Song
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
5401 N Knoxville Ave, Peoria, IL, 61614-5098
Phone Number
309-691-1092
Fax Number
309-689-6092
Provider Enumeration Date
07/14/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
036060265 05 IL
07221997 01 IL BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
5401 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61614-5098
Phone Number
309-691-1092
Fax Number
309-689-6092
person
Provider Business Mailing Address Details
Address
5401 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61614-5098
Phone Number
309-691-1092
Fax Number
309-689-6092
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
-
Taxonomy
208600000X
License No.
036060265 (Illinois)
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Vascular Surgery
Taxonomy
2086S0129X
License No.
036060265 (Illinois)
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
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