Individual
SOO MI LEE - SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
390 E CONGRESS PKWY, SUITE J, CRYSTAL LAKE, IL 60014-6202
(815) 356-5050
(815) 356-5094
Mailing address
1701 E. WOODFIELD ROAD, SUITE 1000, SCHAUMBURG, IL 60173-5113
(847) 240-2211
(847) 240-2418
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036-109024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633897
GROUP BCBS NUMBER
IL
Enumeration date
01/11/2007
Last updated
08/24/2010
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