Provider Demographics
NPI:1922297282
Name:TEE, KIM K (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:K
Last Name:TEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6983 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5295
Mailing Address - Country:US
Mailing Address - Phone:312-949-9999
Mailing Address - Fax:312-949-9100
Practice Address - Street 1:601 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3022
Practice Address - Country:US
Practice Address - Phone:312-949-9999
Practice Address - Fax:312-949-9100
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL989011Medicare PIN
ILU35731Medicare UPIN