Individual provider Active NPI

Michael Jae Lee, M.D.

  • Plastic Surgery Physician
  • Chicago, IL
National Provider Identifier
1265429302
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
036102034 Issued in IL
Practice address
676 N Saint Clair St
Suite 2010
Chicago, IL 60611-2922
Phone
(312) 926-5800
Fax
(312) 926-6190
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 036102034 IL Primary

Addresses

Primary practice location

676 N Saint Clair St
Suite 2010
Chicago, IL 60611-2922

Mailing address

676 N Saint Clair St
Suite 2010
Chicago, IL 60611-2922
Phone (312) 926-5800

Other identifiers 1

IdentifierTypeStateIssuer
K47967OtherILMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041223000006 IL Practitioner - Plastic and Reconstructive Surgery 9739147620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Michigan Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

676 N Saint Clair St
Suite 2010
Chicago, IL 60611-2907

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036102034ILMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jan 1, 2013 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jan 1, 2013 Accepting new patients
Central Dupage Physician Group PastSince Jan 1, 2007 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

676 N Saint Clair St
Ste 300
Chicago, IL 60611
Phone (312) 787-2773

251 E Huron St
Chicago, IL 60611

259 E Erie St
Ste 2300
Chicago, IL 60611
Phone (312) 695-6000

676 N Saint Clair St
Ste 370
Chicago, IL 60611
Phone (312) 787-6662

676 N Saint Clair St
Ste 2010
Chicago, IL 60611
Phone (312) 926-5800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1265429302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST",
            "address_2": "SUITE 2010",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112922",
            "telephone_number": "312-926-5800",
            "fax_number": "312-926-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST",
            "address_2": "SUITE 2010",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112922",
            "telephone_number": "312-926-5800",
            "fax_number": "312-926-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MICHAEL",
        "middle_name": "JAE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036102034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K47967",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.