Provider Demographics
NPI:1023308202
Name:LEE, BOEUN (MD)
Entity type:Individual
Prefix:
First Name:BOEUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:STE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:2923 N CALIFORNIA AVE
Practice Address - Street 2:STE 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7702
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:630-734-4715
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2015-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036131221207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131221Medicaid
IL036131221Medicaid