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NPI Code Detail

MEDICARE: MOSES S LEE M.D.

MEDICARE: MOSES S 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
1207P00000XEmergency Medicine Physician036078482IL

General Provider Information

NPI Number : 1578662185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOSES S LEE M.D.
Provider Business Mailing Address
First Line : 195 N HARBOR DR
Second Line : #2209
City : CHICAGO
State : IL
Zip : 60601-7514
Country : US
Telephone Number : 312-864-0060
Fax Number : 312-864-9656
Provider Business Practice Location Address
First Line : 645 S CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60644-5059
Country : US
Telephone Number : 773-626-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 04/26/2021

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