Provider Demographics
NPI:1104868165
Name:LEE, STEPHEN
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5114
Mailing Address - Country:US
Mailing Address - Phone:630-312-7755
Mailing Address - Fax:630-856-9933
Practice Address - Street 1:1000 REMINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5114
Practice Address - Country:US
Practice Address - Phone:630-312-7755
Practice Address - Fax:630-856-9933
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098026207RA0000X
IL036098026208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00471356OtherMEDICARE RAILROAD
ILK44824Medicare PIN
IL036-098026Medicaid
ILK44823Medicare PIN
ILH08393Medicare UPIN