Provider Demographics
NPI:1811218035
Name:KUO, SHINIE LEE (MD)
Entity Type:Individual
Prefix:
First Name:SHINIE
Middle Name:LEE
Last Name:KUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHINIE
Other - Middle Name:PATRICIA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:3RD FLOOR TAUBMAN CENTER RECP B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-5582
Practice Address - Fax:734-647-9443
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096831390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program