Provider Demographics
NPI:1639133671
Name:CHUA LEE, ANTONIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:A
Last Name:CHUA LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:A
Other - Last Name:CHUA LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1524 ROSEHALL CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN CREEK
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3281
Mailing Address - Country:US
Mailing Address - Phone:847-367-1755
Mailing Address - Fax:847-367-1757
Practice Address - Street 1:14588 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3039
Practice Address - Country:US
Practice Address - Phone:847-367-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-046980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL315170Medicare PIN
ILP01309941Medicare PIN
ILD11015Medicare UPIN
IL113910517Medicare PIN