Individual
ROBERT LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
53822 GENERATIONS DR, SOUTH BEND, IN 46635-1543
(574) 233-3711
(574) 288-1702
Mailing address
53822 GENERATIONS DR, SOUTH BEND, IN 46635-1543
(574) 233-3711
(574) 288-1702
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01048726A
IN
207WX0107X
Retina Specialist (Ophthalmology) Physician
01048726A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093609
BLUE SHIELD
IN
01
—
000000550384
ANTHEM
IN
05
—
200182540
—
IN
05
—
200883090A
—
IN
05
—
4134100
—
MI
Enumeration date
07/21/2005
Last updated
07/12/2017
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