Provider Demographics
NPI:1659488500
Name:LEE, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 W LOOMIS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4858
Mailing Address - Country:US
Mailing Address - Phone:414-281-4466
Mailing Address - Fax:414-281-4528
Practice Address - Street 1:2424 S 90TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2455
Practice Address - Country:US
Practice Address - Phone:414-328-8800
Practice Address - Fax:414-328-8802
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-11-19
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Provider Licenses
StateLicense IDTaxonomies
WI42101207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33324200Medicaid
WI33324200Medicaid
H15678Medicare UPIN