Provider Demographics
NPI:1730364845
Name:CYNTHIA J. LEE, M.D., S.C.
Entity type:Organization
Organization Name:CYNTHIA J. LEE, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-787-6700
Mailing Address - Street 1:2667 FARRAGUT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-8414
Mailing Address - Country:US
Mailing Address - Phone:217-787-6700
Mailing Address - Fax:217-787-9763
Practice Address - Street 1:2667 FARRAGUT DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-8414
Practice Address - Country:US
Practice Address - Phone:217-787-6700
Practice Address - Fax:217-787-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty