Provider Demographics
NPI:1689698326
Name:LEE, CATHERINE H (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 REENA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3145
Mailing Address - Country:US
Mailing Address - Phone:920-563-7366
Mailing Address - Fax:
Practice Address - Street 1:740 REENA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3145
Practice Address - Country:US
Practice Address - Phone:920-563-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36647-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689698326Medicaid
WIP00719953Medicare PIN
WI741501884Medicare PIN
WI543400498Medicare PIN
WI32124000Medicaid
WI130800401Medicare PIN