Provider Demographics
NPI:1467847475
Name:LEE, TRACY (DPM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 GEORGETOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:866-344-3338
Mailing Address - Fax:
Practice Address - Street 1:2230 STAFFORD RD STE 145
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2793
Practice Address - Country:US
Practice Address - Phone:866-344-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001275A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty