Provider Demographics
NPI:1831957257
Name:LEE, TYLOR KUE (MD)
Entity type:Individual
Prefix:
First Name:TYLOR
Middle Name:KUE
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 1:901 S ASHLAND AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4084
Mailing Address - Country:US
Mailing Address - Phone:678-576-0003
Mailing Address - Fax:
Practice Address - Street 1:901 S ASHLAND AVE APT 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4084
Practice Address - Country:US
Practice Address - Phone:678-576-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2025-06-02
Deactivation Date:2025-03-24
Deactivation Code:
Reactivation Date:2025-05-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program