Healthcare Provider Details

I. General information

NPI: 1861498578
Provider Name (Legal Business Name): LEE M UGOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE. 3010
PHOENIX AZ
85020-2437
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1168
  • Fax: 602-861-1763
Mailing address:
  • Phone: 623-434-6200
  • Fax: 623-780-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: