MR. MALCOLM MANDELA LEE SR. (NPI# 1659805521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659805521 |
| Entity Type | Individual |
| Full Name | MR. MALCOLM MANDELA LEE SR. |
| Credential | PHLEBOTOMIST |
| Practice Address |
48 Brook Park Ln Park Forest IL 60466-2642 |
| Practice Telephone | 7087318444 |
| Mailing Telephone | 7087318444 |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2020-09-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156F00000X | Technician/Technologist | Eye and Vision Services Providers | ||
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
1659805521 | IL | Allopathic & Osteopathic Physicians |
| N | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
Technologists, Technicians & Other Technical Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 22232 Rockingham Rd, Richton Park, IL 604711119 | 7082004979 |
| Street Address |
48 BROOK PARK LN |
| City | PARK FOREST |
| State | IL |
| Zip Code | 60466-2642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003464926 | Elda Jean Davis | Technician | 208 Juniper St, Park Forest, IL 60466 | 2019-09-04 |
| 1558806224 | Cindy Okolo | Nurse Practitioner | 111 E Sycamore Drive Suite 303, Park Forest, IL 60466 | 2017-01-04 |
| 1063891984 | April Washington | Occupational Therapist | 2 Lakewood Ct, Park Forest, IL 60466 | 2015-05-26 |
| 1093940363 | Andrene Renee Johnson | Durable Medical Equipment & Medical Supplies | 3224 S Western Ave, Park Forest, IL 60466 | 2009-05-15 |
| 1316181597 | Aunt Martha's Youth Service Center, Inc | Community Based Residential Treatment Facility, Mental Illness | 101 Wolpers Rd, Park Forest, IL 60466 | 2009-05-01 |
| 1255504155 | Joyce N Onyenso | Registered Nurse | 1037 Monterey Ct, University Park, IL 60466 | 2008-04-11 |
| 1891812327 | Comgraph Inc. | Clinic/Center | 252 Main Street, Park Forest, IL 60466 | 2007-03-22 |
| 1992800890 | Village of Park Forest | Home Health | 350 Victory Drive, Lower Level, Park Forest, IL 60466 | 2006-09-14 |
| 1366468324 | Reliable Healthcare Service LLC | Registered Nurse | 220 Forest Blvd, Park Forest Blvd, IL 60466 | 2006-07-14 |
| 1881257806 | Healing Steps Counseling, PC | Clinic/Center | 230 Main St, Park Forest, IL 60466 | 2019-04-16 |
| Find all providers in zip 60466 | ||||
| Taxonomy Code | 156F00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| A broad category grouping different kinds of technologists and technicians. See individual definitions. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528696119 | Timothy Niehaus | Technician/Technologist | 2058 N Cleveland Ave Apt 2, Chicago, IL 60614-7140 | 2020-03-30 |
| 1972143238 | Tamiere Cannon | Technician/Technologist | 3616 W A St Apt 1, Belleville, IL 62226-6269 | 2020-01-14 |
| 1669012373 | Nancy Elizabeth Ottinger | Technician/Technologist | 1311 Adams St, Lake In The Hills, IL 60156-1041 | 2020-01-10 |
| 1619537347 | Tachandra Ohearn | Technician/Technologist | 1740 W 83rd St, Chicago, IL 60620-4623 | 2019-06-14 |
| 1760973325 | Mildred White | Technician/Technologist | 9343 S Sangamon St, Chicago, IL 60620-2734 | 2018-05-19 |
| 1104947316 | Jack Ching Shaw | Technician/Technologist | 2906 N Broadway St, Chicago, IL 60657-7163 | 2007-04-03 |
| 1801987367 | Arseneau Optical of Kankakee Inc | Technician/Technologist | 135 W Court St, Kankakee, IL 60901 | 2006-09-27 |
| 1225638877 | Christine Marie Desparrois | Technician/Technologist | 5000 S 5th Ave, Hines, IL 60141-3030 | 2020-10-31 |
| 1417419045 | Latifa Omran | Technician/Technologist | 1400 W Park St, Urbana, IL 61801-2334 | 2019-04-02 |
| 1659854719 | Pamela Blalock | Technician/Technologist | 1909 Cheker Sq, East Hazel Crest, IL 60429-1442 | 2018-09-13 |
| Find all providers with the same taxonomy | ||||
| City | PARK FOREST |
| Zip Code | 60466 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.