Individual
PETER KISUK LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2116 CRAIG RD, MMC - EAU CLAIRE MEDICAL OFFICES, EAU CLAIRE, WI 54701-6149
(715) 858-4500
(715) 858-4502
Mailing address
2116 CRAIG RD, MMC - EAU CLAIRE MEDICAL OFFICES, EAU CLAIRE, WI 54701-6149
(715) 858-4500
(715) 858-4502
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
40742
MN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
20286
WI
207ND0101X
MOHS-Micrographic Surgery Physician
40742
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-00010
MEDICA-PRIMARY
MN
01
—
0300035
MEDICA-CHOICE
MN
05
—
0512590
—
IA
01
—
070012427
RR MEDICARE
—
01
—
1018635
PREFERRED ONE
MN
01
—
11G68LE
BCBS
MN
01
—
121915
UCARE
MN
05
—
383318600
—
MN
01
—
656310
ARAZ
MN
01
—
HP27293
HEALTH PARTNERS
MN
Enumeration date
10/18/2006
Last updated
12/21/2021
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