Provider Demographics
NPI:1578524385
Name:LEE, DAVID KERN (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KERN
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18731 N REEMS RD STE 640
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8644
Mailing Address - Country:US
Mailing Address - Phone:623-328-8577
Mailing Address - Fax:623-428-0363
Practice Address - Street 1:18731 N REEMS RD STE 640
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8644
Practice Address - Country:US
Practice Address - Phone:623-328-8577
Practice Address - Fax:623-428-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0619213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119036Medicaid
AZZ123917Medicare PIN
AZU41989Medicare UPIN