Provider Demographics
NPI:1487640728
Name:LEE, KI CHUL (MD)
Entity Type:Individual
Prefix:MR
First Name:KI
Middle Name:CHUL
Last Name:LEE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:STE 370
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-484-4451
Mailing Address - Fax:517-484-0291
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 370
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-4451
Practice Address - Fax:517-484-0291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301033392207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00462Medicare UPIN