Provider Demographics
NPI:1265466742
Name:LEE, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
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 1:7840 W 165TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3021
Mailing Address - Country:US
Mailing Address - Phone:913-373-2141
Mailing Address - Fax:913-373-2146
Practice Address - Street 1:7840 W 165TH ST STE 160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3021
Practice Address - Country:US
Practice Address - Phone:913-373-2141
Practice Address - Fax:913-373-2146
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6N44207Q00000X
KS0429116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100413250AMedicaid
KSG934110Medicare ID - Type Unspecified
KS100413250AMedicaid