Provider Demographics
NPI:1174739957
Name:LEE, MICHAEL H (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:LEE
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 1:2420 S UNION AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-272-8148
Mailing Address - Fax:253-404-0506
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-272-8148
Practice Address - Fax:253-404-0506
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010532207RG0100X
WATD60102809207RG0100X
WI51193-20207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8545972Medicaid
WACD8128OtherRR MEDICARE #
WA8545972Medicaid
WI007273844Medicare PIN
WAG8851594Medicare PIN
WAG8851597Medicare PIN
WA000188100Medicare PIN
WACD8128OtherRR MEDICARE #
WAG8880511Medicare PIN
WAG8883340Medicare PIN
WAG8851596Medicare PIN
WAG8883339Medicare PIN
WI002065003Medicare PIN
WI006952540Medicare PIN
WA8851594Medicare PIN
WA001045700Medicare PIN