Healthcare Provider Details

I. General information

NPI: 1780712026
Provider Name (Legal Business Name): JAMES N LEE MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N REGENCY DR
BLOOMINGTON IL
61701-3515
US

IV. Provider business mailing address

4 CHERRYWOOD LN
BLOOMINGTON IL
61701-2059
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-8393
  • Fax:
Mailing address:
  • Phone: 309-662-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 309-663-8393