Provider Demographics
NPI:1932183753
Name:MABEE, LEE MAITLAND JR (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MAITLAND
Last Name:MABEE
Suffix:JR
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 1:1115 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1013
Mailing Address - Country:US
Mailing Address - Phone:605-399-1783
Mailing Address - Fax:605-367-7157
Practice Address - Street 1:1115 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1013
Practice Address - Country:US
Practice Address - Phone:605-399-1783
Practice Address - Fax:605-367-7157
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1932183753Medicaid
0009398OtherWELLMARK
228834OtherMIDLANDS CHOICE
SD6200392Medicaid
22232OtherSIOUX VALLEY HEALTH PLAN
IA1932183753Medicaid
SD6200392Medicaid