Provider Demographics
NPI:1912350703
Name:LEE, DANIEL JARON
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JARON
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18304 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2977
Mailing Address - Country:US
Mailing Address - Phone:313-653-1288
Mailing Address - Fax:
Practice Address - Street 1:9501 IRIS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-5707
Practice Address - Country:US
Practice Address - Phone:313-340-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver