Healthcare Provider Details

I. General information

NPI: 1003077223
Provider Name (Legal Business Name): JASON ALLEN LEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 05/31/2023
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HILLCREST DRIVE
HUDSON WI
54016-4439
US

IV. Provider business mailing address

2651 HILLCREST DRIVE SUITE 303
HUDSON WI
54016-4439
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6800
  • Fax: 715-531-6801
Mailing address:
  • Phone: 715-531-6800
  • Fax: 715-531-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number56974
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number56974
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: