Provider Demographics
NPI:1811423783
Name:LEE, ANDREW M (CSA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 E 93RD ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4602
Mailing Address - Country:US
Mailing Address - Phone:918-633-7914
Mailing Address - Fax:615-346-9258
Practice Address - Street 1:2717 E 93RD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4602
Practice Address - Country:US
Practice Address - Phone:918-633-7914
Practice Address - Fax:615-346-9258
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK172767246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant