Provider Demographics
NPI:1164490363
Name:LEE, KAMTHORN S (MD)
Entity Type:Individual
Prefix:
First Name:KAMTHORN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 NAAB RD
Mailing Address - Street 2:STE. 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-338-6666
Mailing Address - Fax:317-338-6066
Practice Address - Street 1:8333 NAAB RD
Practice Address - Street 2:STE. 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5924
Practice Address - Country:US
Practice Address - Phone:317-338-6666
Practice Address - Fax:317-338-6066
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042692A207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100467890Medicaid
IN060065123OtherRRMC - CARDIOVASCULAR DIAGNOSTIC SERVICES
IN183380FMedicare PIN
IN060065123OtherRRMC - CARDIOVASCULAR DIAGNOSTIC SERVICES
INM400015051Medicare PIN