Active NPI
Eui-Dong Lee, MD
- Surgery Physician
- Paw Paw, MI
National Provider Identifier
1861479891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301032196
- Practice address
- 404 Hazen St
Suite 101
Paw Paw, MI 49079-1040 - Phone
- (269) 657-4407
- Fax
- (269) 657-0965
- NPI assigned
- Dec 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301032196 | MI | Primary |
Addresses
Primary practice location
404 Hazen St
Suite 101
Paw Paw, MI 49079-1040
Mailing address
601 John St
Box 42
Kalamazoo, MI 49007-5341
Phone (269) 341-7806
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700H060020 | Other | MI | BCBSM |
| 1861479891 | Medicaid | MI | |
| 104994926 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253059200000",
"number": "1861479891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 JOHN ST",
"address_2": "BOX 42",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490075341",
"telephone_number": "269-341-7806",
"fax_number": "269-341-8743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 HAZEN ST",
"address_2": "SUITE 101",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490791040",
"telephone_number": "269-657-4407",
"fax_number": "269-657-0965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EUI-DONG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2009-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301032196",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "700H060020",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861479891",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104994926",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Paw Paw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.