Provider Demographics
NPI:1992871438
Name:LEE, JULIET (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JULIET
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-3804
Mailing Address - Country:US
Mailing Address - Phone:773-301-9801
Mailing Address - Fax:
Practice Address - Street 1:9710 STIRLING RD
Practice Address - Street 2:STE 112
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8018
Practice Address - Country:US
Practice Address - Phone:954-392-7700
Practice Address - Fax:954-392-7711
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLYING FORMedicare PIN