Provider Demographics
NPI:1497860373
Name:LEE, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 SALT CREEK LANE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3640
Mailing Address - Country:US
Mailing Address - Phone:630-789-2260
Mailing Address - Fax:630-789-1584
Practice Address - Street 1:12 SALT CREEK LANE
Practice Address - Street 2:SUITE 425
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3640
Practice Address - Country:US
Practice Address - Phone:630-789-2260
Practice Address - Fax:630-789-1584
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036086465207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086465Medicaid
IL362658747OtherFEDERAL TAX ID
IL036086465Medicaid
ILF74480Medicare UPIN