Provider Demographics
NPI:1740230275
Name:BIBLO, LEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:BIBLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:ELECTROPHYSIOLOGY/CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0533
Mailing Address - Fax:414-805-0454
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:ELECTROPHYSIOLOGY/CARDIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0533
Practice Address - Fax:414-805-0454
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI44995207R00000X, 207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
008000261IOtherHUMANA
WI1740230275Medicaid
WI013P 73-601Medicare PIN
E29074Medicare UPIN