Provider Demographics
NPI:1861498578
Name:UGOL, LEE M (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:M
Last Name:UGOL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-780-3752
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:STE. 3010
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:602-861-1168
Practice Address - Fax:602-861-1763
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-09-18
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Provider Licenses
StateLicense IDTaxonomies
AZ21873207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060042397OtherRAILROAD MEDICARE
AZ1Z1417OtherHEALTHNET
AZ155409Medicaid
AZ25-00203OtherUNITED HEALTHCARE
AZAZ0802410OtherBLUE CROSS BLUE SHIELD
AZ060042397OtherRAILROAD MEDICARE
AZAZ0802410OtherBLUE CROSS BLUE SHIELD