Provider Demographics
NPI:1740243989
Name:LEE, ELBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELBERT
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1005 HEALTH CENTER DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-258-4042
Mailing Address - Fax:217-258-4053
Practice Address - Street 1:1005 HEALTH CENTER DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938
Practice Address - Country:US
Practice Address - Phone:217-258-4042
Practice Address - Fax:217-258-4053
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360968772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH4443OtherRR GROUP NUMBER
IL036096877Medicaid
IL260045697OtherRRR MEDICARE NUMBER
ILF32396Medicare UPIN
ILCH4443OtherRR GROUP NUMBER
IL036096877Medicaid