Provider Demographics
NPI:1568629327
Name:LEE KIRCHNER MD PA
Entity Type:Organization
Organization Name:LEE KIRCHNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-9830
Mailing Address - Street 1:3619 PAESANOS PARKWAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1255
Mailing Address - Country:US
Mailing Address - Phone:210-614-9830
Mailing Address - Fax:210-614-9831
Practice Address - Street 1:3619 PAESANOS PARKWAY
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1255
Practice Address - Country:US
Practice Address - Phone:210-614-9830
Practice Address - Fax:210-614-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ91352080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160911701Medicaid