Individual
MIKYUNG LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-5204
(608) 263-0946
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
229632
NY
207RI0200X
Infectious Disease Physician
229632
NY
207RI0200X
Infectious Disease Physician
Primary
83394-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000114410
GHI - HMO
—
01
—
0140665
GHI PPO PROVIDER ID
—
01
—
07020900104
FIDELIS CARE OF NY
—
01
—
10119993-U104
CDPHP PROVIDER # &GRP #
—
01
—
1423323
AETNA HMO
—
01
—
31967773
CIGNA HEALTH CARE
—
01
—
396943
MVP HEALTHPLAN
—
01
—
450AP1
EMPIRE BC-BS
—
01
—
7988846
AETNA PROVIDER ID PPO
—
01
—
NWH TAX ID
DEVON HEALTH GRP PIN#
—
01
—
P003676971
RAILROAD MEDICARE PIN#
—
Enumeration date
11/08/2006
Last updated
03/05/2024
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