Provider Demographics
NPI:1417022740
Name:ROBAK, LEE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:ROBAK
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 1:1316 JACKIE RD SE STE 900
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6612
Mailing Address - Country:US
Mailing Address - Phone:505-892-7518
Mailing Address - Fax:505-892-9092
Practice Address - Street 1:1316 JACKIE RD SE STE 900
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6612
Practice Address - Country:US
Practice Address - Phone:505-892-7518
Practice Address - Fax:505-892-9092
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95 86207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR5756Medicaid
NMR5756Medicaid