Healthcare Provider Details

I. General information

NPI: 1902647951
Provider Name (Legal Business Name): CHIA-MING LEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PLYMOUTH RD BLDG 35-1411
ANN ARBOR MI
48109-2800
US

IV. Provider business mailing address

19756 HAGGERTY RD APT D236
LIVONIA MI
48152-1494
US

V. Phone/Fax

Practice location:
  • Phone: 800-862-7284
  • Fax:
Mailing address:
  • Phone: 716-239-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number5151016630
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number5151016630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: