Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD424317 | PA |
N | 2081P2900X | Pain Medicine | MD424317 | PA |
NPI | 1417969395 |
---|---|
Provider Name | Michael S Lee |
First Address | Malvern, PA 19355-3256 |
Second Address | Malvern, PA 19355-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
639494 | MEDICARE (01) | PA |
H45629 | (02) | PA |