Provider Demographics
NPI:1487798971
Name:LEE CHUY, ISMAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:LEE CHUY
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 1:410 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3936
Mailing Address - Country:US
Mailing Address - Phone:630-695-8401
Mailing Address - Fax:847-336-1601
Practice Address - Street 1:410 HICKORY ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3936
Practice Address - Country:US
Practice Address - Phone:630-695-8401
Practice Address - Fax:847-336-1601
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16792Medicare UPIN