Individual
LISA PENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 339-3583
Mailing address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 339-3583
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036104558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104558
—
IL
Enumeration date
11/29/2006
Last updated
07/18/2024
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