Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 16457 | NV |
Y | 111NI0900X | Internist | 16457 | NV |
NPI | 1003176215 |
---|---|
Provider Name | Michael M Lee |
First Address | Las Vegas, NV 89102-5816 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 28/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16457 | MEDICAL LICENSE (01) | NV |