Provider Demographics
NPI:1497966824
Name:LEE, SIEMAY CHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:SIEMAY
Middle Name:CHANG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6767 WEST 29TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5474
Mailing Address - Country:US
Mailing Address - Phone:970-652-2433
Mailing Address - Fax:970-652-2252
Practice Address - Street 1:6767 WEST 29TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2433
Practice Address - Fax:970-652-2252
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11789207R00000X
CODR.0052999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19052863Medicaid
NVV105678Medicare PIN
CO19052863Medicaid