Healthcare Provider Details

I. General information

NPI: 1063457828
Provider Name (Legal Business Name): CYNTHIA HUEI-CHUNG CHOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SHERWOOD DR
LAKE BLUFF IL
60044-2203
US

IV. Provider business mailing address

917 SHERWOOD DR
LAKE BLUFF IL
60044-2203
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-1220
  • Fax: 847-295-1225
Mailing address:
  • Phone: 847-295-1220
  • Fax: 847-295-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36100304
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: