Individual
MAERRY LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1718
(847) 570-2114
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1718
(847) 570-2114
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-100508
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361005083
—
IL
01
—
P00417662
RAILROAD MCR
—
Enumeration date
01/04/2007
Last updated
11/19/2016
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