Individual
MICHAEL LEE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1110 BERGSLIEN STREET, BALDWIN, WI 54002
(715) 684-1111
Mailing address
1100 BERGSLIEN ST, BALDWIN, WI 54002-2600
(715) 684-1111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
17115
SD
207Q00000X
Family Medicine Physician
Primary
56257-20
WI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
39759
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062832
—
WI
01
—
227GD3O
BLUE CROSS/BLUE SHIELD
MN
Enumeration date
09/26/2006
Last updated
06/10/2025
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