Provider Demographics
NPI:1275590523
Name:LEE, MICHAEL WON KYU (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WON KYU
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2392 LAKE ANGELUS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ANGELUS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1008
Mailing Address - Country:US
Mailing Address - Phone:248-709-4430
Mailing Address - Fax:
Practice Address - Street 1:22250 PROVIDENCE DR STE 206
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6210
Practice Address - Country:US
Practice Address - Phone:248-709-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065895208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3282501Medicaid
G13795Medicare UPIN
OM29150Medicare ID - Type Unspecified