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NPI Code Detail

MEDICARE: EUGENE LEE M.D.

MEDICARE: EUGENE 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
1208600000XSurgery Physician036065069IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036065069OTHERILSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306835244
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUGENE LEE M.D.
Provider Business Mailing Address
First Line : 4309 W MEDICAL CENTER DR STE B202
Second Line :
City : MCHENRY
State : IL
Zip : 60050-8417
Country : US
Telephone Number : 815-455-2752
Fax Number : 815-455-2789
Provider Business Practice Location Address
First Line : 4309 W MEDICAL CENTER DR STE B202
Second Line :
City : MCHENRY
State : IL
Zip : 60050-8417
Country : US
Telephone Number : 815-455-2752
Fax Number : 815-455-2789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 03/18/2019

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