SOO MI LEE - SAMUEL (NPI# 1275683211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1275683211 |
Entity Type | Individual |
Full Name | SOO MI LEE - SAMUEL |
Other Name | DR. SOO MI LEE |
Credential | MD |
Practice Address |
390 E Congress Pkwy Suite J Crystal Lake IL 60014-6202 |
Mailing Address |
1701 E. Woodfield Road Suite 1000 Schaumburg IL 60173-5113 |
Practice Telephone | 8153565050 |
Practice Fax Number | 8153565094 |
Mailing Telephone | 8472402211 |
Mailing Fax Number | 8472402418 |
Enumeration Date | 2007-01-11 |
Last Update Date | 2010-08-24 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
036-109024 | IL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | GROUP BCBS NUMBER | 1633897 | 01 |
Street Address |
390 E CONGRESS PKWY SUITE J |
City | CRYSTAL LAKE |
State | IL |
Zip Code | 60014-6202 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790887040 | Jeana Altman | Counselor | 390 E Congress Pkwy, Suite J, Crystal Lake, IL 60014-6202 | 2006-09-05 |
1851812507 | Amy Lynn Boyce | Audiologist | 390 E Congress Pkwy, Crystal Lake, IL 60014 | 2017-07-03 |
1730632407 | Joanna Hutson | Nurse Practitioner | 390 E Congress Pkwy, Suite C, Crystal Lake, IL 60014-6202 | 2016-07-29 |
1134578453 | Nicole A Glinski | Occupational Therapy Assistant | 390 E Congress Pkwy, Crystal Lake, IL 60014-6202 | 2016-06-07 |
1447634472 | Allyson D Weiss | Audiologist | 390 E Congress Pkwy, Crystal Lake, IL 60014-6202 | 2015-07-20 |
1497137657 | Kathleen Lepage | Speech-Language Pathologist | 390 E Congress Pkwy, Crystal Lake, IL 60014-6202 | 2015-06-24 |
1518367911 | Colleen Ann Rodgers | Occupational Therapy Assistant | 390 E Congress Pkwy, Crystal Lake, IL 60014-6202 | 2014-09-04 |
1225453459 | Steve J Kim | Counselor | 390 E Congress Pkwy, Suite J, Crystal Lake, IL 60014-6202 | 2014-02-25 |
1720425465 | Carissa Lynn Thiele | Speech-Language Pathologist | 390 E Congress Pkwy, Suite A, Crystal Lake, IL 60014-6202 | 2013-06-03 |
1104175447 | Paula Frances Fick | Occupational Therapist | 390 E Congress Pkwy, Suite A, Crystal Lake, IL 60014-6202 | 2012-08-31 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497394720 | Lorelei Mariano | Physical Therapist | 350 E Congress Parkway Ste A, Crystal Lake, IL 60014 | 2020-01-03 |
1396227070 | Behavioral Services for Autism, Inc | Behavioral Analyst | 1095 Pingree Road, Suite 204, Crystal Lake, IL 60014 | 2018-08-30 |
1831635564 | Isis Mendoza-garnica | Counselor | 6803 Rose Ave, Crystal Lake, IL 60014 | 2017-01-19 |
1134664402 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 525 E Congress Parkway, Suite 200, Crystal Lake, IL 60014 | 2016-12-22 |
1306394051 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 177 W Virginia Street, Crystal Lake, IL 60014 | 2016-09-12 |
1124492830 | Align Spine & Orthopaedics | Durable Medical Equipment & Medical Supplies | 60 B West Terra Cotta Ave, #265, Crystal Lake, IL 60014 | 2015-11-18 |
1558747428 | Shabana Nawaz | Optometrist | 4777 Northwest Highway, Crystal Lake, IL 60014 | 2015-08-03 |
1548649205 | Daniel Okon | Social Worker | 304 Charllote Ave, Crystal Lake, IL 60014 | 2015-05-27 |
1154729838 | Crystal Lake Center for Chronic Pain Sc | Nurse Practitioner | 1 South Northwest Highway, Crystal Lake, IL 60014 | 2014-12-12 |
1558763581 | Brooke Nicole Grandt | Occupational Therapist | 394 Heisler Ct, Crystal Lake, IL 60014 | 2014-09-22 |
Find all providers in zip 60014 |
Taxonomy Code | 2084P0804X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Child & Adolescent Psychiatry |
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205834017 | Mohinder Chadha | Psychiatry & Neurology | 500 Coventry Ln, Suite 205, Crystal Lake, IL 60014-7579 | 2005-07-14 |
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1225404551 | Family Renewed, LLC | Psychiatry & Neurology | 1004 Pebble Beach Dr, Caseyville, IL 62232-2834 | 2015-08-21 |
1487032082 | Jerry Francisco Benzl | Psychiatry & Neurology | 1740 Taylor St., Chicago, IL 60612 | 2015-05-14 |
1942697800 | Dr Mo S.c | Psychiatry & Neurology | 2131 W Silverleaf Ln, Addison, IL 60101-6404 | 2015-04-17 |
1104234046 | Hitekshya Nepal | Psychiatry & Neurology | 5230 6th Street Frontage Rd E, Springfield, IL 62703-5128 | 2014-07-23 |
1740558261 | Jyoti Shah | Psychiatry & Neurology | 1335 N Mill St Ste 100, Naperville, IL 60563-2047 | 2011-12-12 |
1083921530 | Jodi Chase | Psychiatry & Neurology | 480 Elm Pl Ste 106, Highland Park, IL 60035-2535 | 2010-09-04 |
Find all providers with the same taxonomy |
City | CRYSTAL LAKE |
Zip Code | 60014 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.