Provider Demographics
NPI:1215951488
Name:HUANG, LEE I (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:I
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LI-I
Other - Middle Name:I
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:729 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2708
Mailing Address - Country:US
Mailing Address - Phone:217-228-0252
Mailing Address - Fax:217-228-3143
Practice Address - Street 1:729 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2708
Practice Address - Country:US
Practice Address - Phone:217-228-0252
Practice Address - Fax:217-228-3143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053121261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center