Provider Demographics
NPI:1679787949
Name:LEE, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1050 REID PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1155
Mailing Address - Country:US
Mailing Address - Phone:765-966-5217
Mailing Address - Fax:765-966-5277
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-966-5217
Practice Address - Fax:765-966-5277
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
MI4301086640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine