Individual
DR. LEE MICHAEL TISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
502 SUE ANN DR, LAKE GENEVA, WI 53147-2341
(262) 248-9727
Mailing address
502 SUE ANN DR, LAKE GENEVA, WI 53147-2341
(262) 248-9727
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016-003410
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003410
—
IL
Enumeration date
08/20/2010
Last updated
08/20/2010
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