MEDICARE: DORIS SHUWEN HUANG FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209-003913	IL
2	363L00000X	Nurse Practitioner	209003913	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400145113	OTHER	IL	MEDICARE PTA

General Provider Information

NPI Number	:	1447304431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS SHUWEN HUANG FNP

Provider Business Mailing Address
First Line	:	PO BOX 7513
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-7513
Country	:	US
Telephone Number	:	312-925-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4332
Country	:	US
Telephone Number	:	773-921-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/03/2022

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Directions to “ DORIS SHUWEN HUANG FNP” Practice Location

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