Healthcare Provider Details

I. General information

NPI: 1740230275
Provider Name (Legal Business Name): LEE A BIBLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE ELECTROPHYSIOLOGY/CARDIOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE ELECTROPHYSIOLOGY/CARDIOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-0533
  • Fax: 414-805-0454
Mailing address:
  • Phone: 414-805-0533
  • Fax: 414-805-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44995
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number44995
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number44995
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: