Provider Demographics
NPI:1033183793
Name:TANG, JUELIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUELIN
Middle Name:
Last Name:TANG
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 1:9710 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3615
Mailing Address - Country:US
Mailing Address - Phone:708-403-7410
Mailing Address - Fax:
Practice Address - Street 1:9710 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3615
Practice Address - Country:US
Practice Address - Phone:708-424-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073144Medicaid
263420 L59569Medicare ID - Type Unspecified