Provider Demographics
NPI:1528124161
Name:LEE MARSHALL DO PC
Entity type:Organization
Organization Name:LEE MARSHALL DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN NEUROLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-208-9411
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1330
Mailing Address - Country:US
Mailing Address - Phone:248-208-9411
Mailing Address - Fax:248-208-9417
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-208-9411
Practice Address - Fax:248-208-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILM0109502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114567651Medicaid
MI1356310544OtherBCBS
MIP00141408OtherPALMETTO
MI1356310544OtherBCBS
MI114567651Medicaid