Provider Demographics
NPI:1588811350
Name:MAO & LEE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MAO & LEE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-8210
Mailing Address - Street 1:2506 NORTH CLARK STREET
Mailing Address - Street 2:282
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 SOUTH MICHIGAN AVENUE
Practice Address - Street 2:403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-842-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36050106174400000X
IL036099238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42324Medicare UPIN
ILH27432Medicare UPIN
IL204774Medicare PIN