Provider Demographics
NPI:1003176215
Name:LEE, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3540 W SAHARA AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:702-921-6823
Mailing Address - Fax:702-549-5240
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2329
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-549-5240
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2016-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV16457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV16457OtherMEDICAL LICENSE