Individual
DOMINGO ANTHONY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8435 CLEARVISTA PLACE, SUITE 101, INDIANAPOLIS, IN 46256
(317) 621-1006
(317) 621-1010
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01038816A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000313231
ANTHEM
IN
01
—
000000700859
ANTHEM
IN
05
—
100121540
—
IN
01
—
P00094602
RR MEDICARE
IN
01
—
P00966919
RR MEDICARE
IN
Enumeration date
07/26/2006
Last updated
06/10/2021
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