Provider Demographics
NPI:1245234111
Name:LEE, ROBERT ELMER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELMER
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6400 DUTCHMANS PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3340
Mailing Address - Country:US
Mailing Address - Phone:502-587-9660
Mailing Address - Fax:502-540-5615
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:STE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY27245207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64272453Medicaid
KY000000062779OtherANTHEM
KY1050714OtherPASSPORT
KY1050714OtherPASSPORT
KYE64789Medicare UPIN
KY64272453Medicaid