MEDICARE: THOMAS MARTIN LEE MD

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	207Q00000X	Family Medicine Physician	01030229	IN
2	207P00000X	Emergency Medicine Physician	01030229A	IN
3	207Q00000X	Family Medicine Physician	01030229A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00049764	OTHER	IN	RR MEDICARE
2	P00968556	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487606083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MARTIN LEE MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 PILGRIM BLVD
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1382
Country	:	US
Telephone Number	:	765-348-5776
Fax Number	:	765-348-3088

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/22/2021

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Directions to “ THOMAS MARTIN LEE MD” Practice Location

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