Basic Information
| Provider Information | |||||||||
| NPI: | 1295734960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9218 | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334689218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617482889 | ||||||||
| FaxNumber: | 5617481523 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 S OLD DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612634400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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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 | 208G00000X | 25MA08616300 | NJ | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | ME104831 | FL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0002 | 01 | BCBS | OTHER | 2139008 | 01 | MAMSI | OTHER | 407954000 | 05 | MD | MEDICAID | 64563901 | 01 | BCBS | OTHER | 3835654 | 01 | AETNA HMO | OTHER | 607156001 | 01 | FEDERAL WORKMANS COMP | OTHER | 250653 | 01 | KAISER | OTHER | 7880154 | 01 | AETNA PPO | OTHER |