1801874599 NPI number — DR. HUI BAE HAROLD LEE M.D.

Table of content: DR. HUI BAE HAROLD LEE M.D. (NPI 1801874599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801874599 NPI number — DR. HUI BAE HAROLD LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
HUI BAE
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
H. B.
Provider Other Middle Name:
HAROLD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801874599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N SHADELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46219-4959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 PENNSYLVANIA PKWY
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46280-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-573-1000
Provider Business Practice Location Address Fax Number:
317-573-0205
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  01063258 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0200X , with the licence number: 01063258A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103446400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200869760 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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