Provider Demographics
NPI:1548242225
Name:LEE, INKU K (MD)
Entity Type:Individual
Prefix:
First Name:INKU
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 1:55 MERIDEN AVE STE 3G
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3237
Mailing Address - Country:US
Mailing Address - Phone:860-276-5107
Mailing Address - Fax:860-276-5173
Practice Address - Street 1:55 MERIDEN AVE STE 3G
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3237
Practice Address - Country:US
Practice Address - Phone:860-276-5107
Practice Address - Fax:860-276-5173
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022527207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001225275Medicaid
CT110004957Medicare ID - Type Unspecified
B83494Medicare UPIN