Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD0000031576 | TN |
NPI | 1053317685 |
---|---|
Provider Name | Michael K Lee |
First Address | Gallatin, TN 37066-3089 |
Second Address | Gallatin, TN 37066-2466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 11/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3158016 | BCBS (01) | TN |
H20169 | (02) |