Individual
JASON DANIEL LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8150 OAKLANDON RD STE 130, INDIANAPOLIS, IN 46236-9554
(317) 621-1111
(317) 621-1110
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01075242A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201311770
—
IN
01
—
P01512418
MEDICARE RR PTAN
IN
Enumeration date
07/06/2012
Last updated
11/27/2023
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