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General NPI Number Information
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NPI Number | 1528124161
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Entity Type | Organization
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Legal Business Name | LEE MARSHALL DO PC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 29829 TELEGRAPH RD SUITE 202
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1330
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Country | US
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Telephone | 248-208-9411
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Fax | 248-208-9417
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Provider Business Mailing Address
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Address Line | 29829 TELEGRAPH RD SUITE 202
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1330
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Country | US
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Telephone | 248-208-9411
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Fax | 248-208-9417
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Authorized Official
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Title or Position | PHYSICIAN NEUROLOGIST PRESIDENT
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Name | LEE BRUCE MARSHALL
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Credential | DO
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Telephone | 248-208-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | LM010950
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License Number State | MI
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