Individual
DR. SAMUEL THEODORE LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125.061701
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
22495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100203539
—
WI
Enumeration date
07/11/2012
Last updated
06/13/2025
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