MEDICARE: HENRY SHIH 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
1	2085R0202X	Diagnostic Radiology Physician	K0106	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81547R	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518960269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY SHIH LEE M.D.

Provider Business Mailing Address
First Line	:	902 FROSTWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2420
Country	:	US
Telephone Number	:	713-461-3573
Fax Number	:	713-468-1247

Provider Business Practice Location Address
First Line	:	902 FROSTWOOD DR
Second Line	:	STE 275
City	:	HOUSTON
State	:	TX
Zip	:	77024-2445
Country	:	US
Telephone Number	:	713-461-3573
Fax Number	:	713-468-1247

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

Provider Enumeration Date	:	05/25/2005
Last Update Date	:	07/08/2007

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