Basic Information
Provider Information | |||||||||
NPI: | 1972743656 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KARA LEE AND ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KARA LEE | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1308 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | MI | ||||||||
PostalCode: | 481702253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7344513440 | ||||||||
FaxNumber: | 7344518720 | ||||||||
Practice Location | |||||||||
Address1: | 1308 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | PLYMOUTH | ||||||||
State: | MI | ||||||||
PostalCode: | 481702253 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7344513440 | ||||||||
FaxNumber: | 7344518720 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/20/2009 | ||||||||
LastUpdateDate: | 02/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MAIER | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 7344513440 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | PHD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 6301008621 | MI | Y |   | Managed Care Organizations | Exclusive Provider Organization |   |
No ID Information.