Provider Demographics
NPI:1285861393
Name:LEE, MICHAEL MARTIN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARTIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 MEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6947
Mailing Address - Country:US
Mailing Address - Phone:559-770-1787
Mailing Address - Fax:
Practice Address - Street 1:937 FRANKLIN AVE
Practice Address - Street 2:NAVAL HEALTH CLINIC LEMOORE
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246
Practice Address - Country:US
Practice Address - Phone:559-998-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01706207Q00000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine