Provider Demographics
NPI:1033452636
Name:LEE, KERRY MELENOVSKY (DO)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MELENOVSKY
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:BRIANNA
Other - Last Name:MELENOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5210 GREENFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6116
Practice Address - Country:US
Practice Address - Phone:248-997-5805
Practice Address - Fax:248-997-5811
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020443207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology