Healthcare Provider Details

I. General information

NPI: 1255021564
Provider Name (Legal Business Name): ANDREW LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 OLSON DR STE 111
PAPILLION NE
68046-2974
US

IV. Provider business mailing address

249 OLSON DR STE 111
PAPILLION NE
68046-2974
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-2200
  • Fax: 402-559-6501
Mailing address:
  • Phone: 402-991-2200
  • Fax: 402-559-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number10475
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR80237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: