Lee - Samuel, Soo Mi

Lee - Samuel, Soo Mi is an individual health care provider with primary practice located at 390 E Congress Pkwy Suite J, Crystal Lake IL 60014-6202. She recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as her primary health care specialty. Lee - Samuel, Soo Mi can be contacted via phone (815) 356-5050.

Contact Information

Primary practice address
390 E Congress Pkwy Suite J Crystal Lake IL 60014-6202
Phone: (815) 356-5050
Fax: (815) 356-5094
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 036-109024 Illinois

Profile Details

NPI number 1275683211
LBN Legal business name Lee - Samuel, Soo Mi
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Aug 24th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275683211 NPPES
Illinois Other 1633897 GROUP BCBS NUMBER

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