Provider Demographics
NPI:1609022516
Name:RICHARD H. LEE M.D., S.C.
Entity Type:Organization
Organization Name:RICHARD H. LEE M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-583-9999
Mailing Address - Street 1:5747 W. DEMPSTER ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3061
Mailing Address - Country:US
Mailing Address - Phone:847-583-9999
Mailing Address - Fax:847-583-0036
Practice Address - Street 1:5747 W. DEMPSTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3061
Practice Address - Country:US
Practice Address - Phone:847-583-9999
Practice Address - Fax:847-583-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085619Medicaid
31604646OtherB/C
ILF603007Medicare UPIN
IL994070Medicare PIN