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General NPI Number Information
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NPI Number | 1285861393
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Entity Type | Individual
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Provider Name | MICHAEL MARTIN LEE DO
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Gender | Male
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-252-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 10349 34TH ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-8488
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Country | US
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Telephone | 559-770-1787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 2010-01706
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2010-01706
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2010-01706
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License Number State | NC
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