Provider Demographics
NPI:1720088032
Name:WEINSTEIN, LEE MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARK
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. BIG BEAVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-205-3535
Mailing Address - Fax:248-649-5920
Practice Address - Street 1:1800 W. BIG BEAVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-205-3535
Practice Address - Fax:248-649-5920
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301-051926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI063869Medicaid
MI063869Medicaid
MI2642110Medicare ID - Type Unspecified