Provider Demographics
NPI:1699003699
Name:ROBERT G LEE P C
Entity Type:Organization
Organization Name:ROBERT G LEE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-894-2949
Mailing Address - Street 1:200 S WENONA ST STE G96
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8831
Mailing Address - Country:US
Mailing Address - Phone:989-894-2949
Mailing Address - Fax:989-894-5848
Practice Address - Street 1:200 S WENONA ST STE G96
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8831
Practice Address - Country:US
Practice Address - Phone:989-894-2949
Practice Address - Fax:989-894-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1070897Medicaid
MI1070897Medicaid
MI0092256Medicare PIN