Individual
DR. KENTON LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3775 N MULFORD RD, ROCKFORD, IL 61114-5632
(779) 696-9202
Mailing address
1601 PARKVIEW AVE, CREDENTIALING S200C, ROCKFORD, IL 61107-1822
(815) 395-5861
(815) 395-5575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036089913
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036089913
STATE LICENSE
IL
05
—
036089913
—
IL
Enumeration date
12/02/2005
Last updated
06/26/2024
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