Healthcare Provider Details

I. General information

NPI: 1790958775
Provider Name (Legal Business Name): JANET TIEN-MING LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 SLOAN PL SUITE 11
SAINT PAUL MN
55117-2087
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 115
MINNEAPOLIS MN
55413-1759
US

V. Phone/Fax

Practice location:
  • Phone: 651-312-1620
  • Fax:
Mailing address:
  • Phone: 651-312-1505
  • Fax: 612-248-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number54177
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: