Provider Demographics
NPI:1588654685
Name:LEE, KATHY H (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13067 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0926
Mailing Address - Country:US
Mailing Address - Phone:813-779-6303
Mailing Address - Fax:888-977-1998
Practice Address - Street 1:13067 N TELECOM PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0926
Practice Address - Country:US
Practice Address - Phone:813-779-6303
Practice Address - Fax:888-977-1998
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60209738207R00000X
FLME94765208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1948791OtherUHC
203070OtherMAGNACARE
183AZOtherEMPIRE BC/BS
21171485677OtherBEECHSTREET
P2668753OtherOXFORD
2514130OtherGHI
NY01872884Medicaid
141435POtherHIP
FL56308OtherBCBS
FL277562000Medicaid
203070OtherMAGNACARE
FL56308OtherBCBS
FLAC237XMedicare UPIN
FLAC237WMedicare UPIN
NY01872884Medicaid
FL277562000Medicaid