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General NPI Number Information
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NPI Number | 1497070502
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Entity Type | Organization
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Legal Business Name | DR. HEATHER K. LEE, D.O., PLLC
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3537 W FRONT ST STE A
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7942
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Country | US
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Telephone | 231-935-9700
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Fax | 231-935-9706
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Provider Business Mailing Address
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Address Line | 3537 W FRONT ST STE A
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7942
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Country | US
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Telephone | 231-935-9700
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Fax | 231-935-9706
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER K LEE
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Credential | D.O.
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Telephone | 231-935-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5101016066
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License Number State | MI
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