Provider Demographics
NPI:1649273319
Name:LEE, CARL WESLEY II (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WESLEY
Last Name:LEE
Suffix:II
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:618-235-3687
Mailing Address - Fax:618-239-9492
Practice Address - Street 1:19 WOLF CREEK DR
Practice Address - Street 2:DEPT OTOLARYNGOLOGY
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2355
Practice Address - Country:US
Practice Address - Phone:618-235-3687
Practice Address - Fax:618-239-9492
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095348207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200080460Medicaid
ILG71837Medicare UPIN
IL036095348Medicaid
IL990012461Medicare PIN