Active NPI
Otto K Lee, MD
- Family Medicine Physician
- Bridgeview, IL
National Provider Identifier
1013108422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036117514
- Practice address
- 7020 W 79TH St
Bridgeview, IL 60455-4030 - Phone
- (708) 599-8200
- Fax
- (708) 599-8306
- NPI assigned
- Aug 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036117514 | IL | Primary |
Addresses
Primary practice location
7020 W 79TH St
Bridgeview, IL 60455-4030
Mailing address
7020 W 79TH St
Bridgeview, IL 60455-4030
Phone (708) 599-8200
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0222075 | Other | IL | BLUE CROSS GROUP NUMBER |
| 363149833 | Other | IL | TAX IDENTIFICATION NUMBER |
| 3631498336019001 | Other | IL | CDPG HFS PAYEE ID |
| 482450 | Other | IL | MEDICARE GROUP NUMBER |
| 036117514 | Medicaid | IL | |
| P00425248 | Other | IL | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1013108422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7020 W 79TH ST",
"city": "BRIDGEVIEW",
"state": "IL",
"postal_code": "604554030",
"telephone_number": "708-599-8200",
"fax_number": "708-599-8306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7020 W 79TH ST",
"city": "BRIDGEVIEW",
"state": "IL",
"postal_code": "604554030",
"telephone_number": "708-599-8200",
"fax_number": "708-599-8306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "OTTO",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-09",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036117514",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS GROUP NUMBER",
"identifier": "0222075",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION NUMBER",
"identifier": "363149833",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPG HFS PAYEE ID",
"identifier": "3631498336019001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "482450",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036117514",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00425248",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.