Provider Demographics
NPI:1548214158
Name:LEE, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:20 NE SAINT LUKE'S BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64086
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-751-8635
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157007207RC0001X, 207RC0000X
KS0428702207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007987051OtherAETNA
007987051OtherAETNA PPO
007987051OtherAETNA HMO
27483016OtherBLUE SHIELD OF KC PPO
MOP00853596Medicaid
431092652 A029OtherCHAMPUS TRICARE
MOP00853596OtherMEDICARE RAILROAD
060060106OtherMEDICARE RAILROAD
27483016OtherPHP FREEDOM
27483016OtherBLUE SHIELD OF KC HMO
G92234Medicare UPIN
431092652 A029OtherCHAMPUS TRICARE
MOP00853596OtherMEDICARE RAILROAD
MOMA3395008Medicare PIN