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General NPI Number Information
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NPI Number | 1306873021
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Entity Type | Individual
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Provider Name | PETER Y LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 1255 MILWAUKEE AVE
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City | GLENVIEW
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State | IL
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Zip | 60025-2425
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Country | US
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Telephone | 847-294-5490
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Fax | 847-294-5496
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Provider Business Mailing Address
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Address Line | 1580 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-4465
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Country | US
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Telephone | 847-733-7344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036090631
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 33289
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License Number State | WI
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