Provider Demographics
NPI:1609886183
Name:PARK, C. LUCY
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:LUCY
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHONGHEE
Other - Middle Name:LUCY
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:606 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3448
Mailing Address - Country:US
Mailing Address - Phone:312-203-5587
Mailing Address - Fax:
Practice Address - Street 1:121 S WILKE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1533
Practice Address - Country:US
Practice Address - Phone:630-599-5444
Practice Address - Fax:630-599-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069211208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics