Provider Demographics
NPI:1104687375
Name:LEE-SINGLETON, KIRA T
Entity type:Individual
Prefix:MS
First Name:KIRA
Middle Name:T
Last Name:LEE-SINGLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1825
Mailing Address - Country:US
Mailing Address - Phone:312-639-4583
Mailing Address - Fax:773-285-8034
Practice Address - Street 1:1400 N MAYWOOD DR
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1825
Practice Address - Country:US
Practice Address - Phone:312-639-4583
Practice Address - Fax:773-285-8034
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL923017038246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information