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General NPI Number Information
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NPI Number | 1447388772
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Entity Type | Organization
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Legal Business Name | DENNIS LEE MD LTD
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 N REGENCY DR
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3515
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Country | US
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Telephone | 309-662-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 15 STONEY CT
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2743
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Country | US
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Telephone | 309-662-5066
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS LEE
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Credential | MD
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Telephone | 309-662-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | IL
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