Individual
CHAN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 838-5150
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 838-5150
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01075343A
IN
207L00000X
Anesthesiology Physician
11016800
IN
207R00000X
Internal Medicine Physician
2010017740
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000943929
ANTHEM PROVIDER NUMBER
IN
01
—
01075343A
MEDICAL LICENSE
IN
05
—
201107640
—
IN
Enumeration date
07/14/2010
Last updated
02/22/2016
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