Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036123623 | IL |
N | 207QS0010X | Family Doctor - Sports Medicine | 036123623 | IL |
NPI | 1265690523 |
---|---|
Provider Name | Dr. Aaron D Lee |
First Address | Berwyn, IL 60402 |
Second Address | Berwyn, IL 60402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 14/07/2010 |