Healthcare Provider Details

I. General information

NPI: 1366536807
Provider Name (Legal Business Name): MICHAEL T LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E. HIGHLAND AVE. SUITE 425
PHOENIX AZ
85016
US

IV. Provider business mailing address

2222 E HIGHLAND AVE STE 425
PHOENIX AZ
85016-4881
US

V. Phone/Fax

Practice location:
  • Phone: 602-667-6640
  • Fax: 602-667-3305
Mailing address:
  • Phone: 602-667-6640
  • Fax: 480-882-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22408
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number22408
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: