Provider Demographics
NPI:1205237104
Name:LEE, JAMES M (DPT, DNP, CNP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT, DNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 S LOWE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-2627
Mailing Address - Country:US
Mailing Address - Phone:630-877-1533
Mailing Address - Fax:
Practice Address - Street 1:779 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3509
Practice Address - Country:US
Practice Address - Phone:312-382-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041453293163W00000X
IL070020199225100000X
IL277001733363LF0000X, 363LP0808X
IL209019688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06191075OtherAANPCB CERTIFICATION
IL377001678OtherCONTROLLED SUBSTANCE
IL041453293OtherRN LICENSE
IL070020199OtherPHYSICAL THERAPY
IL070020199OtherPHYSICAL THERAPY