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General NPI Number Information
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NPI Number | 1750462198
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Entity Type | Individual
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Provider Name | PETER KISUK LEE MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 2116 CRAIG RD MMC - EAU CLAIRE MEDICAL OFFICES
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6149
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Country | US
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Telephone | 715-858-4500
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Fax | 715-858-4502
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Provider Business Mailing Address
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Address Line | 2116 CRAIG RD MMC - EAU CLAIRE MEDICAL OFFICES
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6149
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Country | US
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Telephone | 715-858-4500
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Fax | 715-858-4502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 40742
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 40742
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 20286
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License Number State | WI
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