Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 036115870 | IL |
NPI | 1306880877 |
---|---|
Provider Name | Eric Linden Lee II |
First Address | Frankfort, IL 60423-6733 |
Second Address | Frankfort, IL 60423-6733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 06/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036115870 | (05) | IL |
H92308 | (02) | IL |