Provider Demographics
NPI:1043255672
Name:LUE, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:LUE
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 1:3925 75TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7962
Mailing Address - Country:US
Mailing Address - Phone:630-978-7337
Mailing Address - Fax:630-978-1341
Practice Address - Street 1:3925 75TH ST STE 105
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7962
Practice Address - Country:US
Practice Address - Phone:630-978-7337
Practice Address - Fax:630-978-1341
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107913Medicaid