Healthcare Provider Details

I. General information

NPI: 1710946728
Provider Name (Legal Business Name): JOANN K LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/14/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 ELBOWOODS LOOP
NEW TOWN ND
58763-9112
US

IV. Provider business mailing address

1251 ELBOWOODS LOOP
NEW TOWN ND
58763
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4750
  • Fax:
Mailing address:
  • Phone: 701-627-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47106
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: