MEDICARE: MIMI LEE M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MC 2255	AR

General Provider Information

NPI Number	:	1104959071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMI LEE M.D., P.A.

Provider Business Mailing Address
First Line	:	8315 CANTRELL RD
Second Line	:	PLAZA 80
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2423
Country	:	US
Telephone Number	:	501-224-0880
Fax Number	:	501-224-1395

Provider Business Practice Location Address
First Line	:	8315 CANTRELL RD
Second Line	:	PLAZA 80
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2423
Country	:	US
Telephone Number	:	501-224-0880
Fax Number	:	501-224-1395

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOYUEN MIMI LEE
Credential	:	M.D.
Telephone Number	:	501-224-0880

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	10/22/2008

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