MEDICARE: LEE ROTEM

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1437932399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ROTEM

Provider Business Mailing Address
First Line	:	1500 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2138
Country	:	US
Telephone Number	:	773-383-3221
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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Directions to “ LEE ROTEM ” Practice Location

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