MEDICARE: LEE M UGOL 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	21873	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060042397	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1Z1417	OTHER	AZ	HEALTHNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	25-00203	OTHER	AZ	UNITED HEALTHCARE
5	AZ0802410	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861498578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE M UGOL MD

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	STE. 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	623-434-6200
Fax Number	:	623-780-3752

Provider Business Practice Location Address
First Line	:	9250 N 3RD ST
Second Line	:	STE. 3010
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2437
Country	:	US
Telephone Number	:	602-861-1168
Fax Number	:	602-861-1763

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/18/2013

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Directions to “ LEE M UGOL MD” Practice Location

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