Basic Information
Provider Information
NPI: 1144336074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOI
FirstName: TONY
MiddleName: JEEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2111 MIDLANDS CT
Address2:  
City: SYCAMORE
State: IL
PostalCode: 601783125
CountryCode: US
TelephoneNumber: 8157580000
FaxNumber: 8157567130
Practice Location
Address1: 2111 MIDLANDS CT
Address2:  
City: SYCAMORE
State: IL
PostalCode: 601783125
CountryCode: US
TelephoneNumber: 8157580000
FaxNumber: 8157567130
Other Information
ProviderEnumerationDate: 08/22/2006
LastUpdateDate: 10/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X036123643ILY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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