Healthcare Provider Details

I. General information

NPI: 1750368056
Provider Name (Legal Business Name): JUDY HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E BELVIDERE RD SUITE 200
GRAYSLAKE IL
60030-2082
US

IV. Provider business mailing address

1275 E BELVIDERE RD SUITE 200
GRAYSLAKE IL
60030-2082
US

V. Phone/Fax

Practice location:
  • Phone: 847-918-1462
  • Fax: 847-968-4311
Mailing address:
  • Phone: 847-918-1462
  • Fax: 847-968-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01059780A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number45201-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101241698
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-095207
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22666
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40859
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.091088
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: