Provider Demographics
NPI:1649351115
Name:LEE, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 493-UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-4400
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB NINTH FLOOR, CLINIC 9A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47966207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08-01327OtherMEDICA-CHOICE
MN285468600Medicaid
MNHP55121OtherHEALTH PARTNERS
MT00146149Medicaid
IA0594085Medicaid
MN503K7LEOtherBCBS
MN845347OtherFAIRVIEW
MNB626OtherCHAMPUS
MN08-00043OtherMEDICA-PRIMARY
MN1044742OtherPREFERRED ONE
MN135161OtherUCARE
MN2378191OtherARAZ
WI34656900Medicaid
MN08-01327OtherMEDICA-CHOICE
MN503K7LEOtherBCBS