Healthcare Provider Details

I. General information

NPI: 1245204759
Provider Name (Legal Business Name): JAMES LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S WEBSTER AVE STE 401
GREEN BAY WI
54301-3528
US

IV. Provider business mailing address

704 S WEBSTER AVE STE 401
GREEN BAY WI
54301-3541
US

V. Phone/Fax

Practice location:
  • Phone: 920-436-8284
  • Fax:
Mailing address:
  • Phone: 304-594-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101052917
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20893
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number49054-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: