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NPI Code Detail

MEDICARE: CHUNG SENG LEE M.D.

MEDICARE:   CHUNG SENG LEE  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician01029687AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110002008OTHERINRR MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1093718249
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHUNG SENG LEE M.D.
Provider Business Mailing Address
First Line : 2622 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5410
Country : US
Telephone Number : 260-425-3100
Fax Number : 260-425-3604
Provider Business Practice Location Address
First Line : 2622 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5410
Country : US
Telephone Number : 260-425-3100
Fax Number : 260-425-3604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/13/2015

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Directions to “ CHUNG SENG LEE M.D.” Practice Location

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