Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036073650 | IL |
NPI | 1023091667 |
---|---|
Provider Name | Dr. Ronald D Lee |
First Address | Mount Prospect, IL 60056-6036 |
Second Address | Mount Prospect, IL 60056-6036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 31/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036073650 | (05) | IL |
C41624 | (02) | IL |