Healthcare Provider Details

I. General information

NPI: 1417969395
Provider Name (Legal Business Name): MICHAEL S LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 LANCASTER AVE SUITE 200
MALVERN PA
19355-3256
US

IV. Provider business mailing address

PO BOX 34990
BELFAST ME
04915-0627
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6900
  • Fax: 833-941-3871
Mailing address:
  • Phone: 610-644-6900
  • Fax: 833-941-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD424317
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD424317
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: