Provider Demographics
NPI:1982628475
Name:LEE, BRYAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2650 WARRENVILLE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-324-7900
Mailing Address - Fax:630-324-7942
Practice Address - Street 1:ONE INGALLS DRIVE
Practice Address - Street 2:WEST 536
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-6870
Practice Address - Fax:708-333-9105
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036079191208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36079191Medicaid
E18332Medicare UPIN
ILL67310Medicare ID - Type UnspecifiedWPS MEDICARE
ILL57006Medicare ID - Type UnspecifiedWPS MEDICARE