Provider Demographics
NPI:1851357388
Name:HSU, LEWIS LI-YEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:LI-YEN
Last Name:HSU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:MC 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-6143
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-996-6143
Practice Address - Fax:312-413-9484
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128130208000000X, 2080P0207X
PAMD044248L2080P0207X
DCMD0378352080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00617746Medicaid
PA0019667210001Medicaid
GA617746BMedicaid
GA617746BMedicaid
PAF84519Medicare UPIN
PA072846Medicare ID - Type Unspecified
IL$$$$$$$$$Medicaid