Provider Demographics
NPI:1831399294
Name:LEE, TSONG CHOU (MD)
Entity type:Individual
Prefix:
First Name:TSONG
Middle Name:CHOU
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:HOOPESTON
Mailing Address - State:IL
Mailing Address - Zip Code:60942-1802
Mailing Address - Country:US
Mailing Address - Phone:217-283-5530
Mailing Address - Fax:217-283-6437
Practice Address - Street 1:837 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1802
Practice Address - Country:US
Practice Address - Phone:217-283-5530
Practice Address - Fax:217-283-6437
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-47693207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD09959Medicare UPIN