Provider Demographics
NPI:1457483406
Name:NEVADA LEE MD PC
Entity Type:Organization
Organization Name:NEVADA LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEVADA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-561-8200
Mailing Address - Street 1:800 W 47TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1251
Mailing Address - Country:US
Mailing Address - Phone:816-561-8200
Mailing Address - Fax:816-561-8201
Practice Address - Street 1:800 W 47TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1251
Practice Address - Country:US
Practice Address - Phone:816-561-8200
Practice Address - Fax:816-561-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6C78207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS880000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER