Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 4301062138 | MI |
Y | 207RP1001X | Pulmonary Disease | 4301062138 | MI |
NPI | 1053336057 |
---|---|
Provider Name | Dr. John W Lee |
First Address | Shelby Twp, MI 48315-3140 |
Second Address | Saint Clair Shores, MI 48081-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0E00425 | BLUE CROSS OF MICHIGAN (01) | MI |
290F349720 | BLUE CROSS (01) | MI |
4210946 | (05) | MI |
G98967 | (02) | MI |