MEDICARE: LEE M TYNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	17462020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922098714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE M TYNE MD

Provider Business Mailing Address
First Line	:	19475 W NORTH AVE
Second Line	:	SUITE 201
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4199
Country	:	US
Telephone Number	:	262-780-4400
Fax Number	:	262-780-4425

Provider Business Practice Location Address
First Line	:	2424 S 90TH ST
Second Line	:	SUITE 500
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2455
Country	:	US
Telephone Number	:	414-328-8600
Fax Number	:	414-328-8686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	01/16/2008

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Directions to “ LEE M TYNE MD” Practice Location

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