Individual
BRIAN R LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 N 27TH STREET, MT VERNON, IL 62864
(618) 244-3668
(618) 244-0534
Mailing address
221 N 27TH STREET, MT VERNON, IL 62864
(618) 244-3668
(618) 244-0534
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003846
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060201277
BLUE CROSS/BLUE SHIELD
IL
05
—
016003846
—
IL
01
—
480011933
RAILROAD MEDICARE
IL
Enumeration date
08/30/2006
Last updated
06/16/2008
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