Provider Demographics
NPI:1790989648
Name:KARLA J. LEE MD PA
Entity Type:Organization
Organization Name:KARLA J. LEE MD PA
Other - Org Name:CARDIOLOGY SPECIALITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-310-3600
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-310-3600
Mailing Address - Fax:817-310-3800
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-310-3600
Practice Address - Fax:817-310-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3339207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085QVOtherBCBS-GROUP
TXDF1397OtherMEDICARE RAILROAD
TX0085QVOtherBCBS-GROUP
TXDF1397OtherMEDICARE RAILROAD