MEDICARE: ELLYN 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	MD60455493	WA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036-105594	IL

General Provider Information

NPI Number	:	1982653101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLYN LEE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7043

Provider Business Practice Location Address
First Line	:	1221 MADISON ST
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98104-3588
Country	:	US
Telephone Number	:	206-386-2126
Fax Number	:	206-991-2363

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	05/18/2021

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