Provider Demographics
NPI:1447379375
Name:LEE, MAXIMILIAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 719
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-0604
Mailing Address - Fax:860-247-0422
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 719
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-0604
Practice Address - Fax:860-247-0422
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTCT50907207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
050907OtherCTCARE
CT9044942OtherAETNA
CT9044942OtherAETNA