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NPI Code Detail

MEDICARE: THOMAS D LEE M.D.

MEDICARE: THOMAS D 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
12084P0800XPsychiatry Physician36075700IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801863642
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS D LEE M.D.
Provider Business Mailing Address
First Line : 3436 N. KENNICOTT AVE.
Second Line : ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004
Country : US
Telephone Number : 847-952-7460
Fax Number : 847-222-1754
Provider Business Practice Location Address
First Line : 3436 N KENNICOTT AVE
Second Line : ALEXIAN BROTHERS CENTER FOR MENTAL HEALTH
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-7814
Country : US
Telephone Number : 847-952-7460
Fax Number : 847-222-7154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2006
Last Update Date : 04/21/2016

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