MEDICARE: SWAN 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	208M00000X	Hospitalist Physician	80194	CT
2	208M00000X	Hospitalist Physician	036153804	IL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208M00000X	Hospitalist Physician	334849	NY
5	207R00000X	Internal Medicine Physician	036153804	IL
6	208M00000X	Hospitalist Physician	A178141	CA

General Provider Information

NPI Number	:	1376079707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SWAN LEE M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-570-1010
Fax Number	:	847-733-5108

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:	IM HOSPITALISTS STE 4210
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1010
Fax Number	:	847-733-5108

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

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	12/05/2025

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Directions to “ SWAN LEE M.D.” Practice Location

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