Provider Demographics
NPI:1649255159
Name:LEUNG-STONE, KIM CECILIA (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:CECILIA
Last Name:LEUNG-STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:C
Other - Last Name:LEUNG-STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2501 COMPASS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8000
Mailing Address - Country:US
Mailing Address - Phone:847-901-5200
Mailing Address - Fax:847-904-4917
Practice Address - Street 1:2501 COMPASS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8000
Practice Address - Country:US
Practice Address - Phone:847-901-5200
Practice Address - Fax:847-904-4917
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070938207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031601962OtherBCBS PROVIDER #
1912186024OtherGROUP NPI
IL261093600OtherTAXID/FEIN
216024OtherMEDICARE GROUP PTAN
ILK48469OtherMEDICARE PTAN
P00465920OtherRAILROAD MEDICARE PTAN
GADG9897OtherRAILROAD MEDICARE GROUP NUMBER
GADG9897OtherRAILROAD MEDICARE GROUP NUMBER
1912186024OtherGROUP NPI
216024OtherMEDICARE GROUP PTAN
ILC48922Medicare UPIN