Healthcare Provider Details

I. General information

NPI: 1215951488
Provider Name (Legal Business Name): LEE I HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LI-I I HUANG MD

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 BROADWAY ST
QUINCY IL
62301-2708
US

IV. Provider business mailing address

729 BROADWAY ST
QUINCY IL
62301-2708
US

V. Phone/Fax

Practice location:
  • Phone: 217-228-0252
  • Fax: 217-228-3143
Mailing address:
  • Phone: 217-228-0252
  • Fax: 217-228-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036053121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: