Provider Demographics
NPI:1053310102
Name:LEE, LORIN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORIN
Middle Name:LESLIE
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 SOUTHPOINTE DR STE C3
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7505
Mailing Address - Country:US
Mailing Address - Phone:317-865-6252
Mailing Address - Fax:317-885-5020
Practice Address - Street 1:8920 SOUTHPOINTE DR STE C3
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7505
Practice Address - Country:US
Practice Address - Phone:317-865-6252
Practice Address - Fax:317-885-5020
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025655207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100356430BMedicaid
INC24282Medicare UPIN
IN206290Medicare ID - Type Unspecified