Healthcare Provider Details

I. General information

NPI: 1609886183
Provider Name (Legal Business Name): C. LUCY PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHONGHEE LUCY PARK M.D.

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD SUITE 311
ARLINGTON HEIGHTS IL
60005-1533
US

IV. Provider business mailing address

606 FOREST RD
GLENVIEW IL
60025-3448
US

V. Phone/Fax

Practice location:
  • Phone: 630-599-5444
  • Fax: 630-599-5445
Mailing address:
  • Phone: 312-203-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036069211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: