Provider Demographics
NPI:1235169509
Name:LEE, CINDY M (DO)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-561-5007
Mailing Address - Fax:907-561-5057
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-5007
Practice Address - Fax:907-561-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AK2448207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0105Medicaid
AKMD0105Medicaid
AK152758Medicare ID - Type UnspecifiedPHYSICIAN