Provider Demographics
NPI:1972742591
Name:LEE, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 ROBERT ST N
Mailing Address - Street 2:ST 13-3527
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2037
Mailing Address - Country:US
Mailing Address - Phone:651-665-3527
Mailing Address - Fax:651-665-5960
Practice Address - Street 1:400 ROBERT ST N
Practice Address - Street 2:ST 13-3527
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2037
Practice Address - Country:US
Practice Address - Phone:651-665-3527
Practice Address - Fax:651-665-5960
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN26587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND98250Medicare UPIN