Provider Demographics
NPI:1295026326
Name:LEE, ELLEN CHIAO (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHIAO
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 1:2761 HIDEAWAY LN
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-4484
Mailing Address - Country:US
Mailing Address - Phone:214-734-0684
Mailing Address - Fax:
Practice Address - Street 1:22 PRESTIGE CIRCLE
Practice Address - Street 2:SUITE 200 AND 300
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002
Practice Address - Country:US
Practice Address - Phone:214-383-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ62242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305134403Medicaid
TX483290YRK5Medicare PIN