Healthcare Provider Details

I. General information

NPI: 1134141989
Provider Name (Legal Business Name): TANYA A HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 S WAUKEGAN RD FLOOR 2
LAKE FOREST IL
60045-2654
US

IV. Provider business mailing address

959 S WAUKEGAN RD FLOOR 2
LAKE FOREST IL
60045-2654
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-3250
  • Fax: 847-234-8155
Mailing address:
  • Phone: 847-234-3250
  • Fax: 847-234-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-092828
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: