Healthcare Provider Details

I. General information

NPI: 1720041288
Provider Name (Legal Business Name): ST CLAIR ORTHOPAEDICS AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23829 LITTLE MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-1186
US

IV. Provider business mailing address

22701 HALL RD STE 100
MACOMB MI
48042-5270
US

V. Phone/Fax

Practice location:
  • Phone: 586-773-1300
  • Fax:
Mailing address:
  • Phone: 586-416-4265
  • Fax: 586-416-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. CHRISTOPHER L LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 586-416-1300