Provider Demographics
NPI:1770678997
Name:LEE R. BITTENBENDER, M. D., P. A.
Entity Type:Organization
Organization Name:LEE R. BITTENBENDER, M. D., P. A.
Other - Org Name:DERMATOLOGY CENTER OF LAWRENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BITTENBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:785-842-7001
Mailing Address - Street 1:930 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1835
Mailing Address - Country:US
Mailing Address - Phone:785-842-7001
Mailing Address - Fax:785-842-5847
Practice Address - Street 1:930 IOWA ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1835
Practice Address - Country:US
Practice Address - Phone:785-842-7001
Practice Address - Fax:785-842-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS006529OtherBLUECROSS BLUESHIELD
KS006529OtherBLUECROSS BLUESHIELD
KS006529Medicare ID - Type Unspecified