MEDICARE: DR. ROBERT DM 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
1	207Q00000X	Family Medicine Physician	01039479A	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225031925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DM LEE M.D.

Provider Business Mailing Address
First Line	:	2102 E INWOOD RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-2443
Country	:	US
Telephone Number	:	574-299-2400
Fax Number	:	574-299-2410

Provider Business Practice Location Address
First Line	:	2102 E INWOOD RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-2443
Country	:	US
Telephone Number	:	574-299-2400
Fax Number	:	574-299-2410

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/06/2026

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