Provider Demographics
NPI:1356340244
Name:LEE, NARHA (MD)
Entity type:Individual
Prefix:
First Name:NARHA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2631 WILLIAMSBURG AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1107
Mailing Address - Country:US
Mailing Address - Phone:630-208-7500
Mailing Address - Fax:630-208-7501
Practice Address - Street 1:2631 WILLIAMSBURG AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1107
Practice Address - Country:US
Practice Address - Phone:630-208-7500
Practice Address - Fax:630-208-7501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-086120208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086120Medicaid
IL036086120Medicaid