| Jae Young Lee Md Pc | |
|
130 Washington St Marine City MI 48039-1680 | |
| (810) 765-8844 | |
| (810) 765-4326 |
| Full Name | Jae Young Lee Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 130 Washington St, Marine City, Michigan |
| Authorized Official Name and Position | Jae Young Lee (OWNER) |
| Authorized Official Contact | 8107658844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jae Young Lee Md Pc 130 Washington St Marine City MI 48039-1680 Ph: (810) 765-8844 | Jae Young Lee Md Pc 130 Washington St Marine City MI 48039-1680 Ph: (810) 765-8844 |
| NPI Number | 1811155039 |
|---|---|
| Provider Enumeration Date | 05/23/2008 |
| Last Update Date | 12/29/2010 |
| Medicare PECOS PAC ID | 1355539917 |
|---|---|
| Medicare Enrollment ID | O20101223000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811155039 | NPI | - | NPPES |
| 1068960 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301033400 (Michigan) | Primary |
| Provider Name | Jae Y Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104826973 PECOS PAC ID: 5991993552 Enrollment ID: I20110115000053 |
Pulsar Medical Group Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 538 Broadway St, Marine City, MI 48039 Phone: 810-765-8104 Fax: 810-765-8169 |