Provider Demographics
NPI:1053336057
Name:LEE, JOHN W (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:LEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-314-0080
Mailing Address - Fax:877-673-3562
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-314-0080
Practice Address - Fax:877-673-3562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062138207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00425OtherBLUE CROSS OF MICHIGAN
MI4210946Medicaid
MI290F349720OtherBLUE CROSS
MI4210946Medicaid
MI0F34972Medicare ID - Type UnspecifiedCOMMON PROVIDER CODE