Provider Demographics
NPI:1497882724
Name:LEE, KEVIN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICHARD
Last Name:LEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36622 FIVE MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1900
Mailing Address - Country:US
Mailing Address - Phone:734-542-0200
Mailing Address - Fax:734-542-0220
Practice Address - Street 1:36622 FIVE MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1900
Practice Address - Country:US
Practice Address - Phone:734-542-0200
Practice Address - Fax:734-542-0220
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057469207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4363382Medicaid
MI1406336402OtherBCBS
MIE93972Medicare UPIN
MI0N39530Medicare PIN