Provider Demographics
NPI:1396735114
Name:LEE, FRANCIS CHAEPOONG (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:CHAEPOONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W PERSHING RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1633
Mailing Address - Country:US
Mailing Address - Phone:217-877-7171
Mailing Address - Fax:217-877-7481
Practice Address - Street 1:606 W PERSHING RD
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1633
Practice Address - Country:US
Practice Address - Phone:217-877-7171
Practice Address - Fax:217-877-7481
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036042486207N00000X, 207NS0135X, 207ND0900X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5800184OtherBLUE CROSS BLUE SHIELD
IL036042486Medicaid
ILD10678Medicare UPIN
IL036042486Medicaid