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General NPI Number Information
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NPI Number | 1902905839
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Entity Type | Organization
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Legal Business Name | LEE MEDICAL CLINIC SC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 7114 W. CAPITOL DRIVE
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City | MILWAUKEE
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State | WI
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Zip | 53216
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Country | US
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Telephone | 414-616-8901
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Fax | 414-616-8906
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Provider Business Mailing Address
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Address Line | 7114 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53216-2052
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Country | US
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Telephone | 414-616-8901
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Fax | 414-616-8906
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. CHA LEE
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Credential | MD
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Telephone | 414-616-8901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 42508020
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License Number State | WI
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