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NPI Code Detail

MEDICARE: DR. MICHAEL JAE LEE M.D.

MEDICARE: DR. MICHAEL JAE LEE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician036102034IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K47967OTHERILMEDICARE PTAN

General Provider Information

NPI Number : 1265429302
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL JAE LEE M.D.
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST
Second Line : SUITE 2010
City : CHICAGO
State : IL
Zip : 60611-2922
Country : US
Telephone Number : 312-926-5800
Fax Number : 312-926-6190
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST
Second Line : SUITE 2010
City : CHICAGO
State : IL
Zip : 60611-2922
Country : US
Telephone Number : 312-926-5800
Fax Number : 312-926-6190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 01/22/2013

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