Provider Demographics
NPI:1356454656
Name:LEE, BYUNG SOON (MD)
Entity Type:Individual
Prefix:
First Name:BYUNG
Middle Name:SOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37555 GARFIELD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-263-7150
Mailing Address - Fax:586-263-3212
Practice Address - Street 1:37555 GARFIELD
Practice Address - Street 2:SUITE 125
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-263-7150
Practice Address - Fax:586-263-3212
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035041207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1094333Medicaid
A77257Medicare UPIN
OM82350001Medicare ID - Type Unspecified