Provider Demographics
NPI:1023092715
Name:KLEMENS, LEE JAMES (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:JAMES
Last Name:KLEMENS
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 1:835 S. VANBUREN ST.
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:920-496-4705
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:920-496-4705
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326349135OtherCMH SB NPI
WI11014110Medicaid
WI1851477913OtherNPI CMH
WI390848401050OtherANTHEM
WI39408-20OtherSTATE LICENSE
WI1467583096OtherCMH PCC OF NPI
WI390848401050OtherANTHEM
WIB35512Medicare UPIN
WI1467583096OtherCMH PCC OF NPI