Individual
MARY S LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5799 W MAPLE RD STE 163, WEST BLOOMFIELD, MI 48322-4458
(248) 419-5111
(248) 419-5112
Mailing address
5799 W MAPLE RD STE 163, WEST BLOOMFIELD, MI 48322-4458
(248) 419-5111
(248) 419-5112
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301061252
MI
208000000X
Pediatrics Physician
4301061252
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598296485
—
MI
Enumeration date
11/08/2005
Last updated
01/08/2018
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