Provider Demographics
NPI:1366536807
Name:LEE, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
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 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-667-6640
Mailing Address - Fax:480-882-5052
Practice Address - Street 1:2222 E. HIGHLAND AVE.
Practice Address - Street 2:SUITE 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-667-6640
Practice Address - Fax:602-667-3305
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4193000OtherCIGNA
AZ175829001Medicaid
AZ18-07-2804OtherWORKMENS COMPENSATION
AZPOR13LEE9MI1Medicaid
AZAZ0830720OtherBLUE CROSS BLUE SHIELD
AZ1758293Medicaid
AZAZ0830720OtherBLUE CROSS BLUE SHIELD
AZ175829001Medicaid