MEDICARE: JEAN LEE MD SC

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	174400000X	Specialist	036-099238	IL

General Provider Information

NPI Number	:	1740511278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEAN LEE MD SC

Provider Business Mailing Address
First Line	:	2600 S MICHIGAN AVE # 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 N CLARK ST # 282
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1848
Country	:	US
Telephone Number	:	312-842-8210
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEAN LEE
Credential	:	M.D.
Telephone Number	:	312-842-8210

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	07/16/2010

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