Provider Demographics
NPI:1801863642
Name:LEE, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3436 N. KENNICOTT AVE.
Mailing Address - Street 2:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:847-222-1754
Practice Address - Street 1:3436 N KENNICOTT AVE
Practice Address - Street 2:ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7814
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:847-222-7154
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL360757002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36075700Medicaid
E76786Medicare UPIN