Provider Demographics
NPI:1588654834
Name:LEE, MARVIN II (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:LEE
Suffix:II
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 1:2222 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-776-8040
Mailing Address - Fax:719-776-8050
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-776-8040
Practice Address - Fax:719-776-8050
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108180207R00000X
MT12591207R00000X
CO43946207R00000X
GA058066208M00000X
CODR.0043946208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA299220OtherUHC
GA336127OtherWELLCARE
GA10053493OtherAMERIGROUP
GA445162657AMedicaid
GA52173117OtherBCBS
GAP00351970OtherRR MEDICARE-GRP # CC4177
GA1923803OtherCIGNA
GA336127OtherWELLCARE
GAP00351970OtherRR MEDICARE-GRP # CC4177
GA445162657AMedicaid