Healthcare Provider Details

I. General information

NPI: 1992872634
Provider Name (Legal Business Name): SUK S LEE M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 9TH ST
ROCHESTER IN
46975-8931
US

IV. Provider business mailing address

PO BOX 701
LANSING IL
60438-0701
US

V. Phone/Fax

Practice location:
  • Phone: 574-224-1156
  • Fax:
Mailing address:
  • Phone: 219-322-7042
  • Fax: 219-322-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01030530
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number1030530
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. SUK S LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-322-7042