Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16129 | IL |
NPI | 1003136961 |
---|---|
Provider Name | Stephen Cheukwan Lau |
First Address | Lombard, IL 60148 |
Second Address | Lombard, IL 60148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 02/06/2010 |