MEDICARE: DR. JAMES INKYU LEE DPT

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	225100000X	Physical Therapist	070.018072	IL

General Provider Information

NPI Number	:	1518274380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES INKYU LEE DPT

Provider Business Mailing Address
First Line	:	910 W VAN BUREN ST
Second Line	:	SUITE 419
City	:	CHICAGO
State	:	IL
Zip	:	60607-3523
Country	:	US
Telephone Number	:	877-709-1090
Fax Number	:	866-221-3400

Provider Business Practice Location Address
First Line	:	211 N CLINTON ST
Second Line	:	SUITE 2S
City	:	CHICAGO
State	:	IL
Zip	:	60661-1282
Country	:	US
Telephone Number	:	877-709-1090
Fax Number	:	866-221-3400

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	06/24/2016

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