Provider Demographics
NPI:1881753226
Name:LEE, EDWARD T (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:190 WAUKEGAN RD STE B
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5655
Practice Address - Country:US
Practice Address - Phone:847-945-4575
Practice Address - Fax:847-941-7697
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-10-13
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Provider Licenses
StateLicense IDTaxonomies
IL036-096268207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG98630Medicare UPIN