Provider Demographics
NPI:1811321748
Name:LE, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 MONTAGUE EXPY STE 104
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6809
Mailing Address - Country:US
Mailing Address - Phone:404-408-4444
Mailing Address - Fax:408-357-2631
Practice Address - Street 1:991 MONTAGUE EXPY STE 104
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6809
Practice Address - Country:US
Practice Address - Phone:404-408-4444
Practice Address - Fax:408-357-2631
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CAA143413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital