MEDICARE: DR. HUI BAE HAROLD 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
1	207W00000X	Ophthalmology Physician	01063258	IN
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	01063258A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1801874599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUI BAE HAROLD LEE M.D.

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	:	201 PENNSYLVANIA PKWY
Second Line	:	SUITE 225
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2301
Country	:	US
Telephone Number	:	317-573-1000
Fax Number	:	317-573-0205

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	02/14/2022

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