Basic Information
| Provider Information | |||||||||
| NPI: | 1104868165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 REMINGTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604405114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303127755 | ||||||||
| FaxNumber: | 6308569933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 REMINGTON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604405114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303127755 | ||||||||
| FaxNumber: | 6308569933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | 036-098026 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 208M00000X | 036098026 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.