Individual
DR. ELBERT C. LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 HEALTH CENTER DRIVE, SUITE 102, MATTOON, IL 61938
(217) 258-4042
(217) 258-4053
Mailing address
1005 HEALTH CENTER DRIVE, SUITE 102, MATTOON, IL 61938
(217) 258-4042
(217) 258-4053
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036096877
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096877
—
IL
01
—
260045697
RRR MEDICARE NUMBER
IL
01
—
CH4443
RR GROUP NUMBER
IL
Enumeration date
04/10/2006
Last updated
06/19/2018
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