Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | IL |
NPI | 1063411304 |
---|---|
Provider Name | Mr. Lee G Endsley |
First Address | Decatur, IL 62521-2532 |
Second Address | Decatur, IL 62526-4167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C37911 | (02) |