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Individual

ANITA C LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2427 MALONEY DR, BLOOMINGTON, IL 61704-3750
(309) 663-1011
Mailing address
15 STONEY CT, BLOOMINGTON, IL 61704-2743
(309) 662-5066
(309) 662-5066

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-101027
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036-101027
IL
Enumeration date
12/12/2006
Last updated
04/29/2016
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