Healthcare Provider Details

I. General information

NPI: 1366624439
Provider Name (Legal Business Name): MICHELLE MARIE LEE HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 42ND AVE N
NEW HOPE MN
55427-1225
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 763-971-7878
  • Fax: 612-439-2322
Mailing address:
  • Phone: 732-529-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: