Provider Demographics
NPI:1396830089
Name:LEE, MATTHEW B (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 N 117TH ST # STQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4128
Mailing Address - Country:US
Mailing Address - Phone:414-778-0070
Mailing Address - Fax:414-778-0359
Practice Address - Street 1:3040 N 117TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4128
Practice Address - Country:US
Practice Address - Phone:414-778-0070
Practice Address - Fax:414-778-0359
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38049207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32536900Medicaid
WI32536900Medicaid
WI1002714Medicare ID - Type Unspecified