Provider Demographics
NPI:1790017085
Name:DE DORE, LEE MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:DE DORE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:STE 240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5745
Mailing Address - Country:US
Mailing Address - Phone:630-682-5653
Mailing Address - Fax:630-682-8946
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:SUITE 505
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-682-5653
Practice Address - Fax:630-682-8946
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2017-06-16
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Provider Licenses
StateLicense IDTaxonomies
IL085003692363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical