Healthcare Provider Details

I. General information

NPI: 1528357217
Provider Name (Legal Business Name): MICHAEL LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 DE LA VINA ST
SANTA BARBARA CA
93105-3819
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-687-7444
  • Fax: 805-687-3707
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number57.020173
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA133798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: