MEDICARE: DR. KENNETH ADAM 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	25MA08616300	NJ
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME104831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0002	OTHER	BCBS
2	2139008	OTHER	MAMSI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	64563901	OTHER	BCBS
5	3835654	OTHER	AETNA HMO
6	607156001	OTHER	FEDERAL WORKMANS COMP
7	250653	OTHER	KAISER
8	7880154	OTHER	AETNA PPO

General Provider Information

NPI Number	:	1295734960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ADAM LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 9218
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-9218
Country	:	US
Telephone Number	:	561-748-2889
Fax Number	:	561-748-1523

Provider Business Practice Location Address
First Line	:	1240 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-263-4400
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	09/15/2011

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