MEDICARE: DR. JAMES M LEE DPT, DNP, CNP

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	225100000X	Physical Therapist	070020199	IL
2	363LF0000X	Family Nurse Practitioner	209019688	IL
3	163W00000X	Registered Nurse	041453293	IL
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277001733	IL
5	363LF0000X	Family Nurse Practitioner	277001733	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F06191075	OTHER		AANPCB CERTIFICATION
2	377001678	OTHER	IL	CONTROLLED SUBSTANCE
3	041453293	OTHER	IL	RN LICENSE
4	070020199	OTHER	IL	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1205237104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M LEE DPT, DNP, CNP

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	1804 N NAPER BLVD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8830
Country	:	US
Telephone Number	:	630-527-3645
Fax Number	:	630-646-6504

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	11/18/2025

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