Individual
JOHN K LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4930
(920) 288-4941
Mailing address
164 N BROADWAY, GREEN BAY, WI 54303-2728
(920) 965-4055
(920) 405-5388
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
35836
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104455760
—
MI
01
—
300136760
RAILROAD
WI
05
—
34296700
—
WI
Enumeration date
06/30/2006
Last updated
10/16/2012
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