Provider Demographics
NPI:1831227941
Name:LEUNG, SAMUEL D (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:LEUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HILLCREST COURT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5757
Mailing Address - Country:US
Mailing Address - Phone:630-986-0568
Mailing Address - Fax:312-326-4188
Practice Address - Street 1:2142 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1514
Practice Address - Country:US
Practice Address - Phone:312-326-1400
Practice Address - Fax:312-326-4188
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062409Medicaid
IL672620Medicare ID - Type Unspecified
IL036062409Medicaid