Provider Demographics
NPI:1942270681
Name:LEE, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LEE
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 1:4201 S MINNESOTA AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6706
Mailing Address - Country:US
Mailing Address - Phone:605-335-3349
Mailing Address - Fax:605-336-8436
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:605-335-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1025538OtherPREFERRED ONE
MN1701908OtherMEDICA
MN157457400Medicaid
MN234D1LEOtherBXBS
MN1701908OtherMEDICA
MNH21297Medicare UPIN
MN1025538OtherPREFERRED ONE