Lee, Kenton

Lee, Kenton is an individual health care provider with primary practice located at 3775 N Mulford Rd , Rockford IL 61114-5632. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Lee, Kenton can be contacted via phone (779) 696-9202.

Contact Information

Primary practice address
3775 N Mulford Rd Rockford IL 61114-5632
Phone: (779) 696-9202
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036089913 Illinois

Profile Details

NPI number 1366426397
LBN Legal business name Lee, Kenton
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 2nd, 2005
Last updated Jun 26th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366426397 NPPES
Illinois MEDICAID 036089913
Illinois Other 036089913

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