Provider Demographics
NPI:1992872634
Name:SUK S LEE M.D. INC
Entity type:Organization
Organization Name:SUK S LEE M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUK
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-322-7042
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0701
Mailing Address - Country:US
Mailing Address - Phone:219-322-7042
Mailing Address - Fax:219-322-4155
Practice Address - Street 1:1400 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-8931
Practice Address - Country:US
Practice Address - Phone:574-224-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10305302085N0904X
IN010305302085R0202X
IL2085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5830160036Medicaid
IN498570AMedicare ID - Type Unspecified
ILE03767Medicare UPIN
INE03767Medicare UPIN
IL207522Medicare ID - Type Unspecified