Provider Demographics
NPI:1366648784
Name:BAEK, S. HURN (M D)
Entity Type:Individual
Prefix:
First Name:S. HURN
Middle Name:
Last Name:BAEK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:SANG HEON
Other - Middle Name:
Other - Last Name:BAEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:2150 FOSTERS WAY
Mailing Address - Street 2:#15
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-3343
Mailing Address - Country:US
Mailing Address - Phone:812-385-8082
Mailing Address - Fax:
Practice Address - Street 1:LAWRENCE COUNTY MEMORIAL HOSPITAL, RADIOLOGY
Practice Address - Street 2:2200 W. STATE ST.
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439
Practice Address - Country:US
Practice Address - Phone:618-943-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology