Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 01049528A | IN |
N | 207V00000X | Obstetrician & Gynecologist | 01049528 | IN |
NPI | 1376573832 |
---|---|
Provider Name | Dr. Ivy M Lee |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Bloomington, IN 47403-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200203160 | (05) | IN |
F40622 | (02) | IN |