Provider Demographics
NPI:1609562032
Name:LEE, JOHNNY D JR
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:D
Last Name:LEE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1356
Mailing Address - Country:US
Mailing Address - Phone:262-771-9984
Mailing Address - Fax:
Practice Address - Street 1:4323 N 53RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1356
Practice Address - Country:US
Practice Address - Phone:262-771-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company