MEDICARE: KAMTHORN S LEE MD

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
1	207RC0000X	Cardiovascular Disease Physician	01042692A	IN
2	207R00000X	Internal Medicine Physician	01042692A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	060065123	OTHER	IN	RRMC - CARDIOVASCULAR DIAGNOSTIC SERVICES

General Provider Information

NPI Number	:	1164490363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMTHORN S LEE MD

Provider Business Mailing Address
First Line	:	8333 NAAB RD
Second Line	:	STE. 400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5924
Country	:	US
Telephone Number	:	317-338-6666
Fax Number	:	317-338-6066

Provider Business Practice Location Address
First Line	:	8333 NAAB RD
Second Line	:	STE. 400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5924
Country	:	US
Telephone Number	:	317-338-6666
Fax Number	:	317-338-6066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/14/2010

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Directions to “ KAMTHORN S LEE MD” Practice Location

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