MEDICARE: EUI-DONG LEE MD

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	208600000X	Surgery Physician	4301032196	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H060020	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861479891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUI-DONG LEE MD

Provider Business Mailing Address
First Line	:	601 JOHN ST
Second Line	:	BOX 42
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-341-7806
Fax Number	:	269-341-8743

Provider Business Practice Location Address
First Line	:	404 HAZEN ST
Second Line	:	SUITE 101
City	:	PAW PAW
State	:	MI
Zip	:	49079-1040
Country	:	US
Telephone Number	:	269-657-4407
Fax Number	:	269-657-0965

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	09/16/2009

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