Provider Demographics
NPI:1861495913
Name:LEA, ROBERT SUTTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SUTTON
Last Name:LEA
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:PO BOX 19070
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:24509 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-723-9138
Practice Address - Fax:715-723-8633
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24971207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1020OtherGREATER MARSFIELD PLAN
WI4F991LEOtherBLUE CROSS MINNESOTA
WIW005284OtherCHAMPUS
WI4F991LEOtherATRIUM
WI01-19481OtherMEDICA
WIB54489OtherGROUP HEALTH
WIB54489OtherMA GROUP HEALTH
WI30499400OtherWISCONSIN RISK
WI301025868OtherPREFERRED ONE
WI3080003725OtherTRAVELERS RAILROAD
WI4F991LEOtherATRIUM SENIOR PLAN
WI391435797OtherEMPLOYERS HEALTH
WI0001OtherADVOCARE
WI301813OtherCCN
WI30499400Medicaid
WI3080003725OtherTRAVELERS RAILROAD
WIW005284OtherCHAMPUS
WI01-19481OtherMEDICA