Provider Demographics
NPI:1629005293
Name:LAWRENCE, LEE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JAMES
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16875 VANDERBILT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2777
Mailing Address - Country:US
Mailing Address - Phone:262-352-8299
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:1109 N MAYFAIR RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3430
Practice Address - Country:US
Practice Address - Phone:414-771-3618
Practice Address - Fax:414-290-6755
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29649-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00273828OtherMEDICARE RAILROAD
WI31431300Medicaid
WI930043564OtherMEDICARE RAILROAD
WI0011-68655Medicare ID - Type Unspecified
WI0011-01400Medicare ID - Type Unspecified
WI0014-45034Medicare ID - Type Unspecified
WI31431300Medicaid
WI930043564OtherMEDICARE RAILROAD
WI0012-10006Medicare ID - Type Unspecified