Provider Demographics
NPI:1477571461
Name:LEE, SUNG G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4129 OKEMOS RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2822
Mailing Address - Country:US
Mailing Address - Phone:517-351-1766
Mailing Address - Fax:517-351-3115
Practice Address - Street 1:4129 OKEMOS RD
Practice Address - Street 2:SUITE 7
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2822
Practice Address - Country:US
Practice Address - Phone:517-351-1766
Practice Address - Fax:517-351-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI37010207V00000X
MI037010208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2097438Medicaid
MIB45983Medicare UPIN
MI0336134Medicare ID - Type Unspecified