Provider Demographics
NPI:1316979602
Name:LEE, ERIN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1450 TREAT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2305 CAMINO RAMON
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1396
Practice Address - Country:US
Practice Address - Phone:925-275-3888
Practice Address - Fax:925-275-1036
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA65587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A655870Medicaid
CA00A655870Medicaid
CA00A655872Medicare PIN