MEDICARE: MRS. LISA ANNE LEE ELECTROLOGIST

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	207NS0135X	Procedural Dermatology Physician	2766007124	MI

General Provider Information

NPI Number	:	1568286631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANNE LEE ELECTROLOGIST

Provider Business Mailing Address
First Line	:	5123 W ST JOE HWY STE 102
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-643-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	5123 W ST JOE HWY STE 102
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-643-3244
Fax Number	:

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

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	03/30/2026

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