Healthcare Provider Details

I. General information

NPI: 1194119339
Provider Name (Legal Business Name): RAMON LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 GOVERNORS HWY STE 3600
FLOSSMOOR IL
60422-2147
US

IV. Provider business mailing address

19550 GOVERNORS HWY STE 3600
FLOSSMOOR IL
60422-2147
US

V. Phone/Fax

Practice location:
  • Phone: 708-647-9211
  • Fax: 708-647-9333
Mailing address:
  • Phone: 708-647-9211
  • Fax: 708-647-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036155474
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036155474
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: