Healthcare Provider Details

I. General information

NPI: 1629131727
Provider Name (Legal Business Name): RUSSELL M LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE SUITE 4004
COLORADO SPRINGS CO
80907-6832
US

IV. Provider business mailing address

2312 N NEVADA AVE STE 305
COLORADO SPRINGS CO
80907-5318
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-7064
  • Fax: 719-776-5459
Mailing address:
  • Phone: 719-471-7064
  • Fax: 719-776-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number28832
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number28832
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: