Provider Demographics
NPI:1245270842
Name:LEE, MICHAEL R (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-484-6700
Mailing Address - Fax:970-484-5723
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-484-6700
Practice Address - Fax:970-484-5723
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO43235208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33059268Medicaid
CO33059268Medicaid
COCOA107527Medicare PIN
802026Medicare PIN
P00235528Medicare PIN