MEDICARE: OH JEONG LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036069355	IL
2	207R00000X	Internal Medicine Physician	01035185A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144267444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OH JEONG LEE M.D.

Provider Business Mailing Address
First Line	:	513 RIDGE RD STE 3
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-1648
Country	:	US
Telephone Number	:	219-513-6388
Fax Number	:	219-513-6389

Provider Business Practice Location Address
First Line	:	513 RIDGE RD STE 3
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-1648
Country	:	US
Telephone Number	:	219-513-6388
Fax Number	:	219-513-6389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/20/2025

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Directions to “ OH JEONG LEE M.D.” Practice Location

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