Basic Information
| Provider Information | |||||||||
| NPI: | 1942370440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEE FAMILY PRACTICE,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 QUARRY HILL RD | ||||||||
| Address2: | 11 QUARRY HILL ROAD | ||||||||
| City: | LEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012389645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132430536 | ||||||||
| FaxNumber: | 4132438040 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 QUARRY HILL RD | ||||||||
| Address2: | |||||||||
| City: | LEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012389645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132430536 | ||||||||
| FaxNumber: | 4132438040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4132430536 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 670259 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 9784918 | 05 | MA | MEDICAID | M17158 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |