Provider Demographics
NPI:1124060488
Name:FLEMING, LEE T (DPM)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:T
Last Name:FLEMING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 REVELSTOKE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2025
Mailing Address - Country:US
Mailing Address - Phone:719-574-9800
Mailing Address - Fax:
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3959
Practice Address - Country:US
Practice Address - Phone:719-574-9800
Practice Address - Fax:719-574-9749
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000656213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0470500001Medicare NSC
COC806684Medicare PIN
CO806890Medicare PIN
COV10850Medicare UPIN