SOO MI LEE - SAMUEL MD NPI 1275683211

NPI Information

NPI: 1275683211
Provider Name: SOO MI LEE - SAMUEL, MD
Classification: Psychiatry & Neurology - 2084P0804X
Specialization: Child & Adolescent Psychiatry
Entity Type: Individual
PECOS Registration: Yes
Address: 390 E CONGRESS PKWY
SUITE J
CRYSTAL LAKE, IL
ZIP 60014
Phone: (815) 356-5050

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NPI Details

Soo Mi Lee - Samuel, MD is a child and adolescent psychiatry psychiatry neurology in Crystal Lake, IL with 27 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. Soo Mi Lee - Samuel, MD NPI is 1275683211. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduation Year:1998

The provider's business location address is:

390 E CONGRESS PKWY
SUITE J
CRYSTAL LAKE, IL
ZIP 60014-202
Phone: (815) 356-5050
Fax: (815) 356-5094

The NPI 1275683211 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/11/2007 and was last updated on 8/24/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	036-109024	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	207844	MEDICARE PIN	ILLINOIS
2	32-0084889	OTHER	ILLINOIS	GROUP TAX ID NUMBER
3	1633897	OTHER	ILLINOIS	GROUP BCBS NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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