Healthcare Provider Details

I. General information

NPI: 1114506490
Provider Name (Legal Business Name): AMANDA MEGAN LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MEGAN KARASIC

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6000
  • Fax:
Mailing address:
  • Phone: 651-220-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76502
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: