Healthcare Provider Details

I. General information

NPI: 1184161275
Provider Name (Legal Business Name): JONATHAN YEE RD, CD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226
US

IV. Provider business mailing address

W247N5808 TRAPP TRL
SUSSEX WI
53089-5021
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-7779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2890-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: