Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036131221 | IL |
NPI | 1023308202 |
---|---|
Provider Name | Boeun Lee |
First Address | Burr Ridge, IL 60527-0872 |
Second Address | Chicago, IL 60618-7702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2011 |
Last Update Date | 18/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036131221 | (05) | IL |