Basic Information
| Provider Information | |||||||||
| NPI: | 1699114009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | TIAN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 ERIE CT | ||||||||
| Address2: | SUITE L700 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087631222 | ||||||||
| FaxNumber: | 7087631471 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 POINT BLVD STE 900 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882206432 | ||||||||
| FaxNumber: | 6306544253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125063857 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 036139270 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 036139270 | 05 | IL | MEDICAID |