Provider Demographics
NPI:1861562563
Name:KIM K. TEE, DPM, P. C.
Entity type:Organization
Organization Name:KIM K. TEE, DPM, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:TEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-949-9999
Mailing Address - Street 1:6983 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5295
Mailing Address - Country:US
Mailing Address - Phone:312-949-9999
Mailing Address - Fax:312-949-9100
Practice Address - Street 1:601 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3022
Practice Address - Country:US
Practice Address - Phone:312-949-9999
Practice Address - Fax:312-949-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632003OtherBLUE CROSS BLUE SHIELD
ILU35731Medicare UPIN
IL01632003OtherBLUE CROSS BLUE SHIELD