MEDICARE: ANDREW LEE

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	207RS0010X	Sports Medicine (Internal Medicine) Physician	10475	NE
2	207R00000X	Internal Medicine Physician	R80237	AZ

General Provider Information

NPI Number	:	1255021564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LEE

Provider Business Mailing Address
First Line	:	249 OLSON DR STE 111
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-2974
Country	:	US
Telephone Number	:	402-991-2200
Fax Number	:	402-559-6501

Provider Business Practice Location Address
First Line	:	249 OLSON DR STE 111
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-2974
Country	:	US
Telephone Number	:	402-991-2200
Fax Number	:	402-559-6501

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	06/18/2026

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Directions to “ ANDREW LEE ” Practice Location

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