Provider Demographics
NPI:1235124876
Name:LEE, KATHRYN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 E 2ND ST
Mailing Address - Street 2:102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4548
Mailing Address - Country:US
Mailing Address - Phone:480-607-3800
Mailing Address - Fax:480-607-3808
Practice Address - Street 1:7534 E 2ND ST
Practice Address - Street 2:102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4548
Practice Address - Country:US
Practice Address - Phone:480-607-3800
Practice Address - Fax:480-607-3808
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452350Medicaid
AZZ64519Medicare PIN
AZG59353Medicare UPIN
AZZ161530Medicare PIN
AZ110212756Medicare PIN
AZZ161530Medicare PIN