Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | IL |
NPI | 1760543615 |
---|---|
Provider Name | Dennis Lee |
First Address | Bloomington, IL 61704-2743 |
Second Address | Bloomington, IL 61701-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |