Provider Demographics
NPI:1265635866
Name:LEE, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:LEE
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 1:4311 OAK LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2315
Mailing Address - Country:US
Mailing Address - Phone:469-730-2831
Mailing Address - Fax:469-730-2695
Practice Address - Street 1:4311 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2315
Practice Address - Country:US
Practice Address - Phone:469-730-2831
Practice Address - Fax:469-730-2695
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2059622086S0122X, 207YS0123X
TXM73672086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0026705OtherINSTITUTIONAL PERMIT