Provider Demographics
NPI:1174899066
Name:LEE, VICTORIA S (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W TAYLOR ST RM 2.42
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7242
Mailing Address - Country:US
Mailing Address - Phone:312-996-6582
Mailing Address - Fax:312-996-1282
Practice Address - Street 1:1855 W TAYLOR ST STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7244
Practice Address - Country:US
Practice Address - Phone:312-996-6582
Practice Address - Fax:312-996-1282
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD84759207Y00000X
IL036.150158207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology