Diane C Lee, B.S.
Individual provider Active NPI Specialist · La Grange, IL
NPI 1124293303 · NPPES record last updated Apr 28, 2008
Key facts
- NPI
- 1124293303
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 401 W Elm Ave
La Grange, IL 60525-2203 - Phone
- (708) 642-5090
- Fax
- (708) 579-5960
- NPI assigned
- Apr 28, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
401 W Elm Ave
La Grange, IL 60525-2203
Mailing address
401 W Elm Ave
La Grange, IL 60525-2203
Phone (708) 642-5090
Other providers in La Grange, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.