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General NPI Number Information
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NPI Number | 1356367213
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Entity Type | Individual
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Provider Name | KEVIN HARRY LEE DO
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 574 ALLISON ST
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City | ASHLAND
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State | OR
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Zip | 97520-2910
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Country | US
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Telephone | 989-600-0785
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Fax | 541-789-6461
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Provider Business Mailing Address
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Address Line | 574 ALLISON ST
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City | ASHLAND
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State | OR
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Zip | 97520-2910
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Country | US
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Telephone | 989-600-0785
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Fax | 541-789-6461
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101008929
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License Number State | MI
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