Provider Demographics
NPI:1922088517
Name:LEE, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MICHAEL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19005 WILEYS WELL RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-2287
Mailing Address - Country:US
Mailing Address - Phone:760-296-2468
Mailing Address - Fax:
Practice Address - Street 1:75881 VIA PISA, INDIAN WELLS, CA, USA
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-7849
Practice Address - Country:US
Practice Address - Phone:909-969-8421
Practice Address - Fax:760-404-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68072OtherSTATE LICENSE NUMBER
CAG68072OtherSTATE LICENSE NUMBER
CAD42577Medicare UPIN