Provider Demographics
NPI:1861444994
Name:LEE HO, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:LEE HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 13TH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-346-1102
Mailing Address - Fax:309-347-2885
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-346-1102
Practice Address - Fax:309-347-2885
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00062942OtherRAIL ROAD MEDICARE PIN
IL09015685OtherBLUE CROSS BLUE SHIELD
ILH96306Medicare UPIN
IL207287Medicare PIN