Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036042486 | IL |
N | 207ND0900X | Dermatopathologist | 036042486 | IL |
N | 207NS0135X | Procedural Dermatology | 036042486 | IL |
NPI | 1396735114 |
---|---|
Provider Name | Dr. Francis Chaepoong Lee |
First Address | Decatur, IL 62526-1633 |
Second Address | Decatur, IL 62526-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036042486 | (05) | IL |
5800184 | BLUE CROSS BLUE SHIELD (01) | IL |
D10678 | (02) | IL |