Provider Demographics
NPI:1659396927
Name:LEE, LIEKE T (DPM)
Entity Type:Individual
Prefix:DR
First Name:LIEKE
Middle Name:T
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1211
Mailing Address - Country:US
Mailing Address - Phone:978-361-6964
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:S-411
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-979-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77137OtherMEDICARE GROUP
MA334202OtherHARVARD PILGRIM HEALTHCAR
MA7820474OtherAETNA
MAP00036252OtherRR MEDICARE
MA002200OtherTUFTS INDIVIDUAL
MAY71106OtherBCBSMA
MA720289OtherTUFTS GROUP
MAY77137OtherMEDICARE GROUP
MAU95793Medicare UPIN