Provider Demographics
NPI:1366407827
Name:LEE, MICHAEL S (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12499 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8281
Mailing Address - Country:US
Mailing Address - Phone:515-440-2676
Mailing Address - Fax:515-440-2677
Practice Address - Street 1:12499 UNIVERSITY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-8281
Practice Address - Country:US
Practice Address - Phone:515-440-2676
Practice Address - Fax:515-440-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA00693213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00224046OtherRAILROAD MEDICARE
IA1187369Medicaid
38111OtherWELLMARK BLUE SHIELD
38111OtherWELLMARK BLUE SHIELD
IA1187369Medicaid
IA5686140001Medicare NSC