Provider Demographics
NPI:1700042041
Name:LEE, STEVEN JOO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 S WELLS ST APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4581
Mailing Address - Country:US
Mailing Address - Phone:312-450-7166
Mailing Address - Fax:
Practice Address - Street 1:1400 RENAISSANCE DR STE 216
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1335
Practice Address - Country:US
Practice Address - Phone:224-938-9264
Practice Address - Fax:224-938-9266
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.121174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine