Basic Information
| Provider Information | |||||||||
| NPI: | 1639582596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2723 S 7TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478023558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122381730 | ||||||||
| FaxNumber: | 8122421565 | ||||||||
| Practice Location | |||||||||
| Address1: | 2723 S 7TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478023558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122328164 | ||||||||
| FaxNumber: | 8122346391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 10001669A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.