MEDICARE: WESLEY LEE

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
1	207VM0101X	Maternal & Fetal Medicine Physician	4301054189	MI
2	2085U0001X	Diagnostic Ultrasound Physician	4301054189	MI
3	207VM0101X	Maternal & Fetal Medicine Physician	G7545	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477513174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY LEE

Provider Business Mailing Address
First Line	:	3601 W 13 MILE RD
Second Line	:	400-FSC/PCS
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6651 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2351
Country	:	US
Telephone Number	:	832-826-7449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	06/24/2024

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Directions to “ WESLEY LEE ” Practice Location

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