Provider Demographics
NPI:1043328016
Name:PIATEK, LEE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:J
Last Name:PIATEK
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 1:3405 STUDIO DR
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1937
Mailing Address - Country:US
Mailing Address - Phone:805-995-1873
Mailing Address - Fax:
Practice Address - Street 1:1500 PALM ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2998
Practice Address - Country:US
Practice Address - Phone:805-542-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28265204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G282650Medicaid
CACH658ZOtherPTAN
CA00G282650Medicaid