Individual
JIWON LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 614-9850
(317) 614-9655
Mailing address
PO BOX 7232-DEPT 165, INDIANAPOLIS, IN 46207-7232
(317) 614-9850
(800) 731-0751
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01073766A
IN
208D00000X
General Practice Physician
MT 200476
PA
Other
Enumeration date
08/23/2011
Last updated
06/24/2015
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