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NPI Code Detail

MEDICARE: DR. HEATHER K. LEE, D.O., PLLC

MEDICARE: DR. HEATHER K. LEE, D.O., PLLC
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
1174400000XSpecialist5101016066MI

General Provider Information

NPI Number : 1497070502
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. HEATHER K. LEE, D.O., PLLC
Provider Business Mailing Address
First Line : 3537 W FRONT ST STE A
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7942
Country : US
Telephone Number : 231-935-9700
Fax Number : 231-935-9706
Provider Business Practice Location Address
First Line : 3537 W FRONT ST STE A
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7942
Country : US
Telephone Number : 231-935-9700
Fax Number : 231-935-9706
Authorized Official
Title or Position : OWNER
Name : HEATHER K LEE
Credential : D.O.
Telephone Number : 231-935-9700
Provider Enumeration Date : 03/31/2010
Last Update Date : 01/11/2011

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