Provider Demographics
NPI:1225031925
Name:LEE, ROBERT DM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DM
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 1:2102 E INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2443
Mailing Address - Country:US
Mailing Address - Phone:574-299-2400
Mailing Address - Fax:574-299-2410
Practice Address - Street 1:2102 E INWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2443
Practice Address - Country:US
Practice Address - Phone:574-299-2400
Practice Address - Fax:574-299-2410
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039479A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100143040Medicaid
IN100114340AMedicaid
INM400068391Medicare PIN
IN227950PPMedicare PIN
IN100143040Medicaid