Provider Demographics
NPI:1306873021
Name:LEE, PETER Y (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4465
Mailing Address - Country:US
Mailing Address - Phone:847-733-7344
Mailing Address - Fax:
Practice Address - Street 1:1255 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2425
Practice Address - Country:US
Practice Address - Phone:847-294-5490
Practice Address - Fax:847-294-5496
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090631174400000X
WI33289207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF33745Medicare UPIN