Provider Demographics
NPI:1316007867
Name:LEE, YI SHIUAN JUDY (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:YI SHIUAN
Middle Name:JUDY
Last Name:LEE
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 JOLLY RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3992
Mailing Address - Country:US
Mailing Address - Phone:517-347-8228
Mailing Address - Fax:517-347-8287
Practice Address - Street 1:2169 JOLLY RD
Practice Address - Street 2:UNIT 2
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3992
Practice Address - Country:US
Practice Address - Phone:517-347-8228
Practice Address - Fax:517-347-8287
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066320207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0503302562OtherBC
P00055007OtherRAILROAD MEDICARE
7823128OtherAETNA
M0171703OtherTRICARE PGBA
MI122833OtherCARE CHOICES
MI122833OtherPREFERRED CHOICES
2692375OtherCIGNA
000000008690OtherCAPE HEALTH PLAN
2000053OtherPHP
MI0503302562OtherBC
M0171703OtherTRICARE PGBA