Provider Demographics
NPI:1750368056
Name:HUANG, JUDY (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E BELVIDERE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2082
Mailing Address - Country:US
Mailing Address - Phone:847-918-1462
Mailing Address - Fax:847-968-4311
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-918-1462
Practice Address - Fax:847-968-4311
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059780A2085R0202X
WI45201-0202085R0202X
VA01012416982085R0202X
IL036-0952072085R0202X
WV226662085R0202X
KY408592085R0202X
OH35.0910882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212545OtherGROUP PTAN
IL202926OtherGROUP PTAN
IL036095207Medicaid
WI34393200Medicaid
ILK45887Medicare PIN
ILL93768Medicare PIN
IL036095207Medicaid
WI34393200Medicaid
IL212545OtherGROUP PTAN
IL300106545Medicare PIN
IL202926OtherGROUP PTAN
IL300137124Medicare PIN
ILG76672Medicare UPIN
ILK06060Medicare PIN
ILK22463Medicare PIN
IL212545019Medicare PIN