Provider Demographics
NPI:1235154139
Name:MICHELS, LEE G (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:G
Last Name:MICHELS
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-0053
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:1255 HILYARD STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-7134
Practice Address - Fax:541-687-7135
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD105102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR260869Medicaid
WA8296683Medicaid
AKMD3103RMedicaid
AKMD8670RMedicaid
AK161122Medicare PIN
D72905Medicare UPIN
WA8296683Medicaid
AKMD3103RMedicaid
OR260869Medicaid
AKP00383035Medicare PIN
OR300028228Medicare PIN
OR00WCPGHGMedicare PIN