Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 36106683 | IL |
NPI | 1003843160 |
---|---|
Provider Name | Keith Key Lee |
First Address | Jackson, MI 49201-2218 |
Second Address | Hinsdale, IL 60521-3829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 24/09/2012 |