Healthcare Provider Details

I. General information

NPI: 1811218035
Provider Name (Legal Business Name): SHINIE LEE KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHINIE PATRICIA LEE M.D.

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR 3RD FLOOR TAUBMAN CENTER RECP B
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5582
  • Fax: 734-647-9443
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301096831
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301096831
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: