Provider Demographics
NPI:1366870180
Name:MICHEAL T LEE MD PC
Entity type:Organization
Organization Name:MICHEAL T LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-667-6640
Mailing Address - Street 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-667-6640
Mailing Address - Fax:602-667-3305
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-667-6640
Practice Address - Fax:602-667-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22408207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1758293Medicaid
AZ4193000OtherCIGNA
AZAZ0830720OtherBLUE CROSS BLUE SHIELD
AZPOR13LEE9MI1Medicaid
AZPOR13LEE9MI1Medicaid